Organization
BRAIN AND SPINE INSTITUTE OF CALIFORNIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GOWRIHARAN THAIYANANTHAN M.D. (PRESIDENT)
(203) 376-6364
Entity
Organization
Contact information
Practice address
4631 TELLER AVE STE 100, NEWPORT BEACH, CA 92660-8105
(949) 335-7500
(949) 335-7500
Mailing address
4631 TELLER AVE STE 100, NEWPORT BEACH, CA 92660-8105
(949) 335-7500
(949) 387-1206
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
A103609
CA
207R00000X
Internal Medicine Physician
A31505
CA
207T00000X
Neurological Surgery Physician
A80845
CA
207T00000X
Neurological Surgery Physician
A99924
CA
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
A135941
CA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
A130152
CA
Other
Enumeration date
06/30/2011
Last updated
11/02/2015
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