Healthcare Provider Details

I. General information

NPI: 1235863184
Provider Name (Legal Business Name): NEURANIMUS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N MARKET ST STE 300
SAN JOSE CA
95113-1116
US

IV. Provider business mailing address

1511 3RD AVE STE 1000
SEATTLE WA
98101-3637
US

V. Phone/Fax

Practice location:
  • Phone: 805-608-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL WASSER
Title or Position: MANAGER
Credential:
Phone: 805-608-3600