05D2011818 CLIA NUMBER - LA JOLLA SPINE INSTITUTE MEDICAL GROUP, INC

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Laboratory Demographics

CLIA Number: 05D2011818

Facility Name: LA JOLLA SPINE INSTITUTE MEDICAL GROUP, INC

Facility Address:
6719 ALVARADO RD STE 308
SAN DIEGO, CA
ZIP 92120
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Facility Phone Number: 619 265-7912

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1073677811

Taxonomy: 207XS0117X - Orthopaedic Surgery
Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive.

CLIA Record

Field Name	Field Value
CLIA Number	05D2011818
LAB Type	Physician Office
Facility Name	LA JOLLA SPINE INSTITUTE MEDICAL GROUP, INC
Street	6719 ALVARADO RD STE 308
City	SAN DIEGO
State	CA
ZIP	92120
Phone	619 265-7912
CertificateType	4
CertificateEffectiveDate	1/2/2024
CertificateExpirationDate	1/1/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024