Healthcare Provider Details

I. General information

NPI: 1679214902
Provider Name (Legal Business Name): NEUROVIBE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 AIRWAY AVE STE N2
COSTA MESA CA
92626-4626
US

IV. Provider business mailing address

3151 AIRWAY AVE STE N2
COSTA MESA CA
92626-4626
US

V. Phone/Fax

Practice location:
  • Phone: 949-689-6607
  • Fax:
Mailing address:
  • Phone: 949-689-6607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH KYONG CHOI
Title or Position: MBR
Credential:
Phone: 949-378-7982