Healthcare Provider Details

I. General information

NPI: 1386366755
Provider Name (Legal Business Name): NEUROTREE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 E SOUTHERN AVE FLOORS 1 AND 2
MESA AZ
85206-2569
US

IV. Provider business mailing address

530 S LAKE AVE # 149
PASADENA CA
91101-3515
US

V. Phone/Fax

Practice location:
  • Phone: 424-387-6806
  • Fax:
Mailing address:
  • Phone: 424-387-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID ESRAELIAN
Title or Position: CEO/CO-FOUNDER
Credential:
Phone: 424-387-6806