Healthcare Provider Details

I. General information

NPI: 1619779865
Provider Name (Legal Business Name): CALIFORNIA NEUROSCIENCE SPECIALISTS, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 COLLIER CT
TUSTIN CA
92782-1525
US

IV. Provider business mailing address

12665 GARDEN GROVE BLVD STE 708
GARDEN GROVE CA
92843-1921
US

V. Phone/Fax

Practice location:
  • Phone: 949-870-9784
  • Fax:
Mailing address:
  • Phone: 714-973-1388
  • Fax: 949-284-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MIAN MOHSIN SHAH
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 714-973-1388