1710019039 NPI number — COASTAL NEUROLOGICAL MEDICAL CENTER 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 1710019039 NPI number — COASTAL NEUROLOGICAL MEDICAL CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL NEUROLOGICAL MEDICAL CENTER 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:
1710019039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
264 S LA CIENEGA BLVD
Provider Second Line Business Mailing Address:
SUITE #1149
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90211-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-984-8882
Provider Business Mailing Address Fax Number:
818-898-3956

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
418 SAN FERNANDO MISSION BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FERNANDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91340-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-984-8882
Provider Business Practice Location Address Fax Number:
818-898-3956
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARMANIOUS
Authorized Official First Name:
NADER
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
818-984-8882

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A72796 , 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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