Healthcare Provider Details

I. General information

NPI: 1083074744
Provider Name (Legal Business Name): PRECISE NEURO MANAGEMENT SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 1ST ST STE 250
SIMI VALLEY CA
93065-1574
US

IV. Provider business mailing address

2655 1ST ST STE 250
SIMI VALLEY CA
93065-1574
US

V. Phone/Fax

Practice location:
  • Phone: 310-908-5850
  • Fax: 303-922-4640
Mailing address:
  • Phone: 310-908-5850
  • Fax: 303-922-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JUAN CANTERO
Title or Position: CEO
Credential: MD
Phone: 310-908-5850