Healthcare Provider Details

I. General information

NPI: 1063635126
Provider Name (Legal Business Name): INSTITUTE OF NEUROLOGICAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W AVENUE Q SUITE D
PALMDALE CA
93551-3887
US

IV. Provider business mailing address

615 W AVENUE Q SUITE D
PALMDALE CA
93551-3887
US

V. Phone/Fax

Practice location:
  • Phone: 661-266-4500
  • Fax: 661-266-4502
Mailing address:
  • Phone: 661-266-4500
  • Fax: 661-266-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. AMIR SHAHRAM MAKOUI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-498-1608