Healthcare Provider Details

I. General information

NPI: 1598049272
Provider Name (Legal Business Name): CALIFORNIA CENTER FOR NEUROINTERVENTIONAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 GENESEE AVE 411
LA JOLLA CA
92037-1223
US

IV. Provider business mailing address

23052 ALICIA PKWY # 619
MISSION VIEJO CA
92692-1643
US

V. Phone/Fax

Practice location:
  • Phone: 858-677-1755
  • Fax: 858-677-1771
Mailing address:
  • Phone: 714-808-9797
  • Fax: 714-808-9393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG88237
License Number StateCA

VIII. Authorized Official

Name: DR. GIUSEPPE AMMIRATI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-677-1755