Healthcare Provider Details

I. General information

NPI: 1518359900
Provider Name (Legal Business Name): NEUROMOD SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 DOVE ST SUITE 299
NEWPORT BEACH CA
92660-2433
US

IV. Provider business mailing address

1601 DOVE ST SUITE 299
NEWPORT BEACH CA
92660-2433
US

V. Phone/Fax

Practice location:
  • Phone: 949-851-3086
  • Fax:
Mailing address:
  • Phone: 949-851-3086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT STOLFUS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 949-851-3086