Healthcare Provider Details

I. General information

NPI: 1063401461
Provider Name (Legal Business Name): SURGICAL NEUROMONITORING SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 SANTA MARGARITA CT
SANTA ROSA CA
95405-8205
US

IV. Provider business mailing address

3005 SANTA MARGARITA CT
SANTA ROSA CA
95405-8205
US

V. Phone/Fax

Practice location:
  • Phone: 707-573-2341
  • Fax: 707-539-2939
Mailing address:
  • Phone: 707-573-2341
  • Fax: 707-539-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY12851
License Number StateCA

VIII. Authorized Official

Name: DR. ALEX AMOCHAEV
Title or Position: PRESIDENT
Credential: PHD
Phone: 707-573-2341