Healthcare Provider Details

I. General information

NPI: 1942653258
Provider Name (Legal Business Name): WEST COAST NEURO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3863 SHERWOOD PL
SHERMAN OAKS CA
91423-4607
US

IV. Provider business mailing address

PO BOX 103631
PASADENA CA
91189-6020
US

V. Phone/Fax

Practice location:
  • Phone: 310-953-9759
  • Fax: 213-785-8864
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RYAN FLORES
Title or Position: CEO
Credential:
Phone: 310-953-9759