# MATTHEW ROOT DO INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Innovative Pain and Spine Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760964340
- **Authorized official:** MATTHEW S ROOT D.O. (OWNER)
- **Authorized official phone:** (818) 621-0019

## Contact information

- **Practice address:** 13320 RIVERSIDE DR STE 214, SHERMAN OAKS, CA 91423-2512
- **Practice address phone:** (818) 621-0019
- **Practice address fax:** (818) 671-5556
- **Mailing address:** 13320 RIVERSIDE DR STE 214, SHERMAN OAKS, CA 91423-2512
- **Mailing address phone:** (818) 621-0019
- **Mailing address fax:** (818) 671-5556

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/30/2018
- **Last updated:** 11/07/2022