Organization
MDRS SPINE & SPORT, INC
Active
Organization
MDRS SPINE & SPORT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGEL COLLADO (CREDENTIALING OFFICER)
(858) 264-1417
Entity
Organization
Contact information
Practice address
3707 CONVOY ST STE 100, SAN DIEGO, CA 92111-3754
(858) 573-9368
(858) 874-0582
Mailing address
PO BOX 515746, LOS ANGELES, CA 90051-5120
(888) 208-8526
(858) 751-0901
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
08/29/2005
Last updated
07/08/2026
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