Healthcare Provider Details

I. General information

NPI: 1982887295
Provider Name (Legal Business Name): DESIGN NEUROSCIENCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 17TH STREET
NORTH MIAMI BEACH FL
33169
US

IV. Provider business mailing address

3607 OLD CONEJO ROAD
THOUSAND OAKS CA
91320
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-5755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberOS4703
License Number StateFL

VIII. Authorized Official

Name: KESTER NEDD
Title or Position: PHYSICIAN
Credential:
Phone: 305-653-5155