Healthcare Provider Details

I. General information

NPI: 1619252020
Provider Name (Legal Business Name): HOPE NEUROLOGIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79440 CORPORATE CENTER DR SUITE 108
LA QUINTA CA
92253-7241
US

IV. Provider business mailing address

PO BOX 6613
LA QUINTA CA
92248-6613
US

V. Phone/Fax

Practice location:
  • Phone: 760-514-0166
  • Fax: 760-501-0719
Mailing address:
  • Phone: 760-514-0166
  • Fax: 760-501-0719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA62033
License Number StateCA

VIII. Authorized Official

Name: BHAGWAN MOORJANI
Title or Position: OWNER
Credential: MD
Phone: 760-514-0166