Organization
SPINE & NERVE DIAGNOSTIC CENTER
Active
Organization
SPINE & NERVE DIAGNOSTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINAY MOOLA REDDY M.D. (MD/PRESIDENT)
(916) 772-5325
Entity
Organization
Contact information
Practice address
1528 EUREKA RD STE 103, ROSEVILLE, CA 95661-3047
(916) 772-5325
(916) 772-6333
Mailing address
1528 EUREKA RD STE 103, ROSEVILLE, CA 95661-3047
(916) 772-5325
(916) 772-6333
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
00A63460
CA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
00A63460
CA
208100000X
Physical Medicine & Rehabilitation Physician
00A83749
CA
208VP0000X
Pain Medicine Physician
00A83749
CA
208VP0014X
Interventional Pain Medicine Physician
00A63460
CA
Other
Enumeration date
12/16/2014
Last updated
06/11/2019
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