Provider Demographics
NPI:1871476937
Name:SPINAL DISC SOLUTIONS
Entity type:Organization
Organization Name:SPINAL DISC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAITA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-570-1536
Mailing Address - Street 1:5407 S 18TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-3363
Mailing Address - Country:US
Mailing Address - Phone:480-570-1536
Mailing Address - Fax:480-870-6421
Practice Address - Street 1:2121 S MILL AVE STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2106
Practice Address - Country:US
Practice Address - Phone:602-853-4004
Practice Address - Fax:480-870-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ008885OtherLICENSE
TXT9177OtherLICENSE