1063635126 NPI number — INSTITUTE OF NEUROLOGICAL SURGERY

Table of content: (NPI 1063635126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063635126 NPI number — INSTITUTE OF NEUROLOGICAL SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE OF NEUROLOGICAL SURGERY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063635126
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 W AVENUE Q
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
PALMDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93551-3887
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-266-4500
Provider Business Mailing Address Fax Number:
661-266-4502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 W AVENUE Q
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551-3887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-266-4500
Provider Business Practice Location Address Fax Number:
661-266-4502
Provider Enumeration Date:
04/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAKOUI
Authorized Official First Name:
AMIR
Authorized Official Middle Name:
SHAHRAM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-498-1608

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)