Healthcare Provider Details

I. General information

NPI: 1578288718
Provider Name (Legal Business Name): NEUROFEEDBACK THERAPY OF NORTH COUNTY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 WARING CT STE Q
OCEANSIDE CA
92056-4509
US

IV. Provider business mailing address

3230 WARING CT STE Q
OCEANSIDE CA
92056-4509
US

V. Phone/Fax

Practice location:
  • Phone: 760-591-9975
  • Fax: 760-591-9976
Mailing address:
  • Phone: 760-591-9975
  • Fax: 760-591-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS NAVAZO
Title or Position: PRESIDENT
Credential: MD
Phone: 760-591-9975