# SAN DIEGO SPINE & PAIN CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972955128
- **Authorized official:** LANETTE V. BUMGARDNER (OWNER/CEO)
- **Authorized official phone:** (310) 594-5640

## Contact information

- **Practice address:** 13029 POMERADO RD, SUITE C, POWAY, CA 92064-4246
- **Practice address phone:** (858) 312-5016
- **Practice address fax:** (858) 312-5018
- **Mailing address:** 13029 POMERADO RD, SUITE C, POWAY, CA 92064-4246
- **Mailing address phone:** (858) 312-5016
- **Mailing address fax:** (858) 312-5018

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/11/2016
- **Last updated:** 07/11/2016