Healthcare Provider Details

I. General information

NPI: 1740038082
Provider Name (Legal Business Name): NEURO INTEGRITY PHYSICIANS OVERSIGHT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11049 MAGNOLIA BLVD APT 602
NORTH HOLLYWOOD CA
91601-5664
US

IV. Provider business mailing address

11049 MAGNOLIA BLVD APT 602
NORTH HOLLYWOOD CA
91601-5664
US

V. Phone/Fax

Practice location:
  • Phone: 818-207-0267
  • Fax:
Mailing address:
  • Phone: 818-207-0267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN VITANTONIO
Title or Position: DIRECTOR
Credential: MD
Phone: 310-923-1437