Healthcare Provider Details

I. General information

NPI: 1669894192
Provider Name (Legal Business Name): PRO-NEURO SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3595 INLAND EMPIRE BLVD BLDG 1 SUITE # 1250
ONTARIO CA
91764-7988
US

IV. Provider business mailing address

3595 INLAND EMPIRE BLVD BLDG 1 SUITE # 1250
ONTARIO CA
91764-7988
US

V. Phone/Fax

Practice location:
  • Phone: 909-373-4631
  • Fax: 909-373-4634
Mailing address:
  • Phone: 909-373-4631
  • Fax: 909-373-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246QB0000X
TaxonomyBlood Banking Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246QH0401X
TaxonomyHemapheresis Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE J WRIGHT
Title or Position: CEO
Credential:
Phone: 562-805-1876