Healthcare Provider Details

I. General information

NPI: 1053424432
Provider Name (Legal Business Name): CENTER FOR NEUROLOGICAL STUDY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE SUITE 320
LA JOLLA CA
92037-1224
US

IV. Provider business mailing address

9850 GENESEE AVENUE SUITE 320
LA JOLLA CA
92037
US

V. Phone/Fax

Practice location:
  • Phone: 858-455-5469
  • Fax:
Mailing address:
  • Phone: 858-455-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD A SMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 858-455-5469