Healthcare Provider Details

I. General information

NPI: 1215593652
Provider Name (Legal Business Name): CALIFORNIA INSTITUTE OF NEUROSCIENCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LYNN RD STE 120
THOUSAND OAKS CA
91360-8033
US

IV. Provider business mailing address

3435 E THOUSAND OAKS BLVD UNIT 3789
WESTLAKE VILLAGE CA
91359-7930
US

V. Phone/Fax

Practice location:
  • Phone: 805-795-7656
  • Fax:
Mailing address:
  • Phone: 805-795-7656
  • Fax: 805-618-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: IRINA MURAVYEVA
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 805-795-7565