Healthcare Provider Details

I. General information

NPI: 1841996568
Provider Name (Legal Business Name): NEUROGENIX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3683 E REDFIELD CT
GILBERT AZ
85234-3107
US

IV. Provider business mailing address

12409 W INDIAN SCHOOL RD STE A108
AVONDALE AZ
85392-9503
US

V. Phone/Fax

Practice location:
  • Phone: 623-328-7087
  • Fax:
Mailing address:
  • Phone: 623-328-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: AZIZ MALLIK
Title or Position: MANAGING PARTNER
Credential:
Phone: 623-328-7087