Provider Demographics
NPI:1447524806
Name:LONG BEACH SPINE & REHABILITATION
Entity type:Organization
Organization Name:LONG BEACH SPINE & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. MARTA CALLOTTA DC, CCSP / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CALLOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:562-938-8770
Mailing Address - Street 1:3434 N.LOS COYOTES DIAGONAL
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2915
Mailing Address - Country:US
Mailing Address - Phone:562-938-8770
Mailing Address - Fax:562-938-8762
Practice Address - Street 1:3434 N.LOS COYOTES DIAGONAL
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2915
Practice Address - Country:US
Practice Address - Phone:562-938-8770
Practice Address - Fax:562-938-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24681111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU62641Medicare UPIN