OrganizationActive
Spondylos Medical Group, Inc.
NPI 1104038587 · Orthopaedic Surgery of the Spine Physician · La Jolla, CA
Provider details
- NPI number
- 1104038587
- Entity type
- Organization
- Primary specialty
- Orthopaedic Surgery of the Spine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Bruce Van Dam, President(858) 587-0700
- License
- G35628 (CA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4130 La Jolla Village Dr
Suite 300
La Jolla, CA 92037-9121
Phone: (858) 587-0700
Fax: (858) 587-0401
Street-level locationGet directions
Mailing address
4130 La Jolla Village Dr
La Jolla, CA 92037-9121
Registry dates
- Enumerated
- 2007-05-05
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.