Healthcare Provider Details

I. General information

NPI: 1245587070
Provider Name (Legal Business Name): SOUTHLAND NEUROLOGIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3747 WORSAM AVE, #100
LONG BEACH CA
90808-1774
US

IV. Provider business mailing address

3747 WORSHAM AVE # 100
LONG BEACH CA
90808-1774
US

V. Phone/Fax

Practice location:
  • Phone: 562-430-3114
  • Fax: 562-430-7718
Mailing address:
  • Phone: 562-430-3114
  • Fax: 562-430-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLAN COHEN
Title or Position: PHYSICIAN/CEO
Credential: M.D.
Phone: 562-430-3114