Organization
SPONDYLOS MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE E. VAN DAM M.D. (PRESIDENT)
(858) 587-0700
Entity
Organization
Contact information
Practice address
4130 LA JOLLA VILLAGE DR, SUITE 300, LA JOLLA, CA 92037-9121
(858) 587-0700
(858) 587-0401
Mailing address
4130 LA JOLLA VILLAGE DR, SUITE 300, LA JOLLA, CA 92037-9121
(858) 587-0700
(858) 587-0401
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
G35628
CA
Other
Enumeration date
05/05/2007
Last updated
08/22/2020
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