Provider Demographics
NPI:1730410770
Name:SPINAL AND MULTISPECIALTY SURGICAL GROUP INC
Entity type:Organization
Organization Name:SPINAL AND MULTISPECIALTY SURGICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:CLARLE
Authorized Official - Last Name:MORCOS
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:714-834-1303
Mailing Address - Street 1:999 N TUSTIN AVE STE 13
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3530
Mailing Address - Country:US
Mailing Address - Phone:714-834-1303
Mailing Address - Fax:714-834-2210
Practice Address - Street 1:999 N TUSTIN AVE STE 13
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3530
Practice Address - Country:US
Practice Address - Phone:714-834-1303
Practice Address - Fax:714-834-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72410174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG72410Medicare PIN