1922698091 NPI number — WEST WAVE NEURODIAGNOSTICS LLC

Table of content: (NPI 1922698091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922698091 NPI number — WEST WAVE NEURODIAGNOSTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST WAVE NEURODIAGNOSTICS LLC
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:
1922698091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
937 E MAIN ST STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93454-5309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-357-5272
Provider Business Mailing Address Fax Number:
805-308-7107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
937 E MAIN ST STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454-5309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-357-5272
Provider Business Practice Location Address Fax Number:
805-308-7107
Provider Enumeration Date:
01/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MORROW
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
JEWEL
Authorized Official Title or Position:
OWNER, REGISTERED EEG TECHNOLOGIST
Authorized Official Telephone Number:
805-540-1160

Provider Taxonomy Codes

  • Taxonomy code: 156F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: EIN . This is a "THE EIN FOR THIS COMPANY WAS NOT BY MEDICARE." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com