Provider Demographics
NPI:1902800543
Name:SOUTHERN CALIFORNIA SPINE AND SPORT MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA SPINE AND SPORT MEDICAL ASSOCIATES, INC
Other - Org Name:RMP, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:DELGASH
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-644-5800
Mailing Address - Street 1:1401 AVOCADO AVE STE 709
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8714
Mailing Address - Country:US
Mailing Address - Phone:949-644-5800
Mailing Address - Fax:949-999-5813
Practice Address - Street 1:1401 AVOCADO AVE STE 709
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8714
Practice Address - Country:US
Practice Address - Phone:949-644-5800
Practice Address - Fax:949-999-5813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53385207LP2900X
207LP2900X, 363A00000X, 363AS0400X
CAQ34724363AM0700X
CAPA65976363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ34724Medicare UPIN
CAA93233Medicare UPIN
CAW15898Medicare ID - Type UnspecifiedSCSSMA, INC
CAWPA16211AMedicare ID - Type UnspecifiedRENEE FABRIZI
CAH20339Medicare UPIN
CAWA65482CMedicare ID - Type UnspecifiedDR. ANDREW MERRITT
CAWG53522JMedicare ID - Type UnspecifiedDR. STEPHEN H. BARKOW
CAA52510Medicare UPIN
CAPA65976Medicare UPIN
CAWG53385EMedicare ID - Type UnspecifiedDR. PAICIUS