Healthcare Provider Details

I. General information

NPI: 1407625858
Provider Name (Legal Business Name): TELETHERAPEUTICS HEALTH CALIFORNIA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 RIMPAU AVE STE 102
CORONA CA
92879-5724
US

IV. Provider business mailing address

79 OGLE RD
OLD TAPPAN NJ
07675-7026
US

V. Phone/Fax

Practice location:
  • Phone: 888-420-0589
  • Fax: 888-462-7765
Mailing address:
  • Phone: 888-420-0589
  • Fax: 888-462-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: YASIR J AHMAD
Title or Position: OWNER
Credential:
Phone: 732-485-1301