1336281625 NPI number — PACIFIC CENTER FOR NEUROLOGICAL DISEASE INC

Table of content: (NPI 1336281625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336281625 NPI number — PACIFIC CENTER FOR NEUROLOGICAL DISEASE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC CENTER FOR NEUROLOGICAL DISEASE 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:
1336281625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15708 POMERADO RD STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92064-2035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-674-1289
Provider Business Mailing Address Fax Number:
858-726-6221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15644 POMERADO RD 401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-485-5301
Provider Business Practice Location Address Fax Number:
760-745-4633
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HO
Authorized Official First Name:
GILBERT
Authorized Official Middle Name:
JYY
Authorized Official Title or Position:
CEO/DIRECTOR
Authorized Official Telephone Number:
858-674-1289

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)





Copyright © 2007-2025 www.npivalidator.com