Organization
SPINE & NERVE DIAGNOSTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINAY MOOLA REDDY MD (MD/PRESIDENT)
(916) 772-5325
Entity
Organization
Contact information
Practice address
2234 LONGPORT CT STE 100, ELK GROVE, CA 95758-7181
(916) 478-0112
Mailing address
4200 DOUGLAS BLVD, GRANITE BAY, CA 95746-5902
(916) 772-5325
(916) 772-6333
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA143514
PTAN
CA
Enumeration date
09/21/2015
Last updated
01/12/2024
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