Provider Demographics
NPI:1447880026
Name:TITAN SPINE, PLLC
Entity type:Organization
Organization Name:TITAN SPINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEGAL OPERATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDERETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-598-2801
Mailing Address - Street 1:MSC 484 PO BOX 650097
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0097
Mailing Address - Country:US
Mailing Address - Phone:903-375-0168
Mailing Address - Fax:
Practice Address - Street 1:675 TOWN SQUARE BOULEVARD SUITE 200 1A
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040
Practice Address - Country:US
Practice Address - Phone:903-375-0168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty