Healthcare Provider Details

I. General information

NPI: 1447708441
Provider Name (Legal Business Name): NEUROLOGICAL ASSOCIATES OF IRVINE, SADDLEBACK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24411 HEALTH CENTER DR SUITE 330
LAGUNA HILLS CA
92653-3651
US

IV. Provider business mailing address

PO BOX 54840
LOS ANGELES CA
90054-0840
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-6966
  • Fax: 714-456-8284
Mailing address:
  • Phone: 714-456-3856
  • Fax: 714-456-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL PORTO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-456-2986