Healthcare Provider Details

I. General information

NPI: 1508637604
Provider Name (Legal Business Name): NEUROLOGICAL INJURY SPECIALISTS MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WILSHIRE BLVD STE 310
SANTA MONICA CA
90401-1895
US

IV. Provider business mailing address

900 WILSHIRE BLVD STE 310
SANTA MONICA CA
90401-1895
US

V. Phone/Fax

Practice location:
  • Phone: 310-314-6410
  • Fax: 310-496-0185
Mailing address:
  • Phone: 310-314-6410
  • Fax: 310-496-0185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON GERSHON FILLER
Title or Position: PRESIDENT
Credential: MD
Phone: 310-314-6410