Organization
CENTER FOR INTERVENTIONAL SPINE, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLEY GEARITY (CREDENTIALING SPECIALIST)
(727) 877-5419
Entity
Organization
Contact information
Practice address
1817 PROFESSIONAL DRIVE, SACRAMENTO, CA 95825
(727) 877-5419
(727) 877-5419
Mailing address
311 PARK PLACE BLVD, 5TH FLOOR, CLEARWATER, FL 33759
(727) 877-5419
(727) 877-5419
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
A60900
CA
Other
Enumeration date
07/15/2015
Last updated
07/15/2015
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