1639306780 NPI number — CALIFORNIA NEUROMEDICAL SERVICES, INC.

Table of content: (NPI 1639306780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639306780 NPI number — CALIFORNIA NEUROMEDICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA NEUROMEDICAL SERVICES, 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:
1639306780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3201 OVERLAND AVE
Provider Second Line Business Mailing Address:
STE 9130
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90034-4574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-557-8727
Provider Business Mailing Address Fax Number:
310-680-0305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 BROOKSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE # 102
Provider Business Practice Location Address City Name:
REDLANDS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92373-4611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-557-8727
Provider Business Practice Location Address Fax Number:
909-792-2565
Provider Enumeration Date:
06/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
ROSABEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-428-2244

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  G64157 , 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)





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