1457855322 NPI number — LOS ANGELES NEUROSCIENCES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457855322 NPI number — LOS ANGELES NEUROSCIENCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS ANGELES NEUROSCIENCES, INC.
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:
6
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:
1457855322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25614 TRENT WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEVENSON RANCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91381-1471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23861 MCBEAN PKWY STE E12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-2077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-857-7100
Provider Business Practice Location Address Fax Number:
661-481-0239
Provider Enumeration Date:
03/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GARIBAY
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
661-857-7100

Provider Taxonomy Codes

  • Taxonomy code: 2084N0402X , with the licence number:  A130877 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00 . This is a "N/A" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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