1801449392 NPI number — NEUROLOGY AND COGNITIVE NEUROSCIENCE INSTITUTE, 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 1801449392 NPI number — NEUROLOGY AND COGNITIVE NEUROSCIENCE INSTITUTE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGY AND COGNITIVE NEUROSCIENCE INSTITUTE, 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:
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:
1801449392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2080 CENTURY PARK E STE 1403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90067-2017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-638-7637
Provider Business Mailing Address Fax Number:
310-526-8770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2080 CENTURY PARK E STE 1403
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90067-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-239-4410
Provider Business Practice Location Address Fax Number:
310-526-8770
Provider Enumeration Date:
07/23/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PEDOUIM
Authorized Official First Name:
FARZIN
Authorized Official Middle Name:
BENJAMIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-562-5589

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)