Healthcare Provider Details

I. General information

NPI: 1083051023
Provider Name (Legal Business Name): UNITED NEUROLOGY ASSOCIATES A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR
LA MESA CA
91942-3017
US

IV. Provider business mailing address

8851 CENTER DR
LA MESA CA
91942-3017
US

V. Phone/Fax

Practice location:
  • Phone: 760-751-5324
  • Fax: 760-751-5328
Mailing address:
  • Phone: 760-751-5324
  • Fax: 760-751-5328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA71659
License Number StateCA

VIII. Authorized Official

Name: DR. ER-KAI GAO
Title or Position: BOARD MEMBER
Credential: MD
Phone: 760-751-5324