Healthcare Provider Details

I. General information

NPI: 1043456742
Provider Name (Legal Business Name): CALIFORNIA NEUROMEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N PRAIRIE AVE STE.315
INGLEWOOD CA
90301-4507
US

IV. Provider business mailing address

511 BROOKSIDE AVE STE. 102
REDLANDS CA
92373-4611
US

V. Phone/Fax

Practice location:
  • Phone: 310-680-0304
  • Fax: 310-680-0305
Mailing address:
  • Phone: 909-557-8727
  • Fax: 909-335-8514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberG64157
License Number StateCA

VIII. Authorized Official

Name: ROSABEL R YOUNG
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 310-428-2244