Healthcare Provider Details

I. General information

NPI: 1932465432
Provider Name (Legal Business Name): INSTITUTE OF NEUROSURGICAL INNOVATION INC A NON-PROFIT PUBLIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SANTA MONICA BLVD # 760W
SANTA MONICA CA
90404
US

IV. Provider business mailing address

3111 VIA DOLCE APT 604
MARINA DEL REY CA
90292-5078
US

V. Phone/Fax

Practice location:
  • Phone: 424-835-0341
  • Fax:
Mailing address:
  • Phone: 424-835-0341
  • Fax:

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 Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AMIR VOKSHOOR
Title or Position: FOUNDER/CEO
Credential: M.D.
Phone: 424-835-0341