Healthcare Provider Details

I. General information

NPI: 1356829634
Provider Name (Legal Business Name): VIGILANT NEUROMONITORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20331 IRVINE AVE STE E2
NEWPORT BEACH CA
92660-0223
US

IV. Provider business mailing address

PO BOX 103907
PASADENA CA
91189-0183
US

V. Phone/Fax

Practice location:
  • Phone: 714-322-1344
  • Fax:
Mailing address:
  • Phone: 714-322-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: TERRY SISCO
Title or Position: CEO
Credential:
Phone: 714-322-1344