Healthcare Provider Details

I. General information

NPI: 1871644658
Provider Name (Legal Business Name): NEUROGRAPHY INSTITUTE MEDICAL ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/29/2022
Certification Date: 10/06/2021
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 TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberFNP 26333
License Number StateCA

VIII. Authorized Official

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