Organization
SPINE & SPORTS SURGICAL CENTER, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY D CARLSON MD (PRESIDENT)
(714) 598-1745
Entity
Organization
Contact information
Practice address
1120 W LA VETA AVE, 300, ORANGE, CA 92868-4231
(714) 598-1745
(714) 941-9539
Mailing address
1120 W LA VETA AVE # 330, ORANGE, CA 92868-4231
(714) 598-1745
(714) 941-9539
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
01/16/2015
Last updated
04/20/2021
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