Healthcare Provider Details

I. General information

NPI: 1104871060
Provider Name (Legal Business Name): NEUROSCAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LA CASA VIA SUITE 202
WALNUT CREEK CA
94598-3042
US

IV. Provider business mailing address

175 LENNON LN SUITE 100
WALNUT CREEK CA
94598-2485
US

V. Phone/Fax

Practice location:
  • Phone: 925-296-7156
  • Fax: 925-296-7174
Mailing address:
  • Phone: 925-296-7156
  • Fax: 925-296-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD MICHAEL SIGEL
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 925-296-7156