1558398842 NPI number — NORTH COUNTY NEUROLOGY ASSOCIATES MEDICAL GROUP

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 1558398842 NPI number — NORTH COUNTY NEUROLOGY ASSOCIATES MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH COUNTY NEUROLOGY ASSOCIATES MEDICAL GROUP
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:
THE NEUROLOGY CENTER
Provider Other Organization Name Type Code:
3
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:
1558398842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6010 HIDDEN VALLEY RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92011-4219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-631-3000
Provider Business Mailing Address Fax Number:
760-631-3007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9888 GENESEE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-626-6939
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAHAGIAN
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
ARAM
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
760-631-3000

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0021850 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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