Healthcare Provider Details

I. General information

NPI: 1326552787
Provider Name (Legal Business Name): PACIFIC NEURODIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CALIFORNIA ST FL 7
SAN FRANCISCO CA
94108-2737
US

IV. Provider business mailing address

650 CALIFORNIA ST 7TH FLOOR, STE 05-145
SAN FRANCISCO CA
94108
US

V. Phone/Fax

Practice location:
  • Phone: 415-500-4383
  • Fax:
Mailing address:
  • Phone: 415-500-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. BEN PATTON
Title or Position: PRINCIPAL
Credential:
Phone: 415-500-4383