Healthcare Provider Details

I. General information

NPI: 1104249291
Provider Name (Legal Business Name): NEUROGRAPHY INSTITUTE GLOBAL CONSULTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 OCEAN PARK BLVD STE 3082
SANTA MONICA CA
90405-5266
US

IV. Provider business mailing address

2716 OCEAN PARK BLVD STE 3082
SANTA MONICA CA
90405-5266
US

V. Phone/Fax

Practice location:
  • Phone: 310-314-6410
  • Fax: 310-314-2414
Mailing address:
  • Phone: 310-314-6410
  • Fax: 310-314-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberG81778
License Number StateCA

VIII. Authorized Official

Name: DR. AARON G FILLER
Title or Position: MEDICAL DIRECTOR
Credential: M.D., PH.D., FRCS
Phone: 310-314-6410