NPIMap

Organization Active NPI

San Diego Spine & Pain Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Poway, CA
National Provider Identifier
1972955128
Registry record updated Jul 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
SAN DIEGO SPINE & PAIN CENTER, LLC
Practice address
13029 Pomerado Rd
Suite C
Poway, CA 92064-4246
Phone
(858) 312-5016
Fax
(858) 312-5018
NPI assigned
Jul 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lanette V. Bumgardner
Title
Owner/Ceo
Phone
(310) 594-5640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

13029 Pomerado Rd
Suite C
Poway, CA 92064-4246

Mailing address

13029 Pomerado Rd
Suite C
Poway, CA 92064-4246
Phone (858) 312-5016

National Provider Directory

National Provider Directory

Locations

13029 Pomerado Rd
Ste C
Poway, CA 92064
Phone (858) 312-5016

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468195200000",
    "number": "1972955128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13029 POMERADO RD",
            "address_2": "SUITE C",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920644246",
            "telephone_number": "858-312-5016",
            "fax_number": "858-312-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13029 POMERADO RD",
            "address_2": "SUITE C",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920644246",
            "telephone_number": "858-312-5016",
            "fax_number": "858-312-5018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO SPINE & PAIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-11",
        "last_updated": "2016-07-11",
        "status": "A",
        "authorized_official_last_name": "BUMGARDNER",
        "authorized_official_first_name": "LANETTE",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "310-594-5640"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poway, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.