Healthcare Provider Details

I. General information

NPI: 1427101658
Provider Name (Legal Business Name): NATIONAL NEURODIAGNOSTIC TECHNOLOGIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 KINGSLEY AVE SUITE 1005
ORANGE PARK FL
32073-4466
US

IV. Provider business mailing address

PO BOX 1450
ORANGE PARK FL
32067-1450
US

V. Phone/Fax

Practice location:
  • Phone: 904-737-5792
  • Fax: 904-737-6541
Mailing address:
  • Phone: 904-737-5792
  • Fax: 904-737-6541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License NumberHCC4403
License Number StateFL

VIII. Authorized Official

Name: MR. AURELIO A. MUZAURIETA JR.
Title or Position: PRESIDENT/TECHNICAL DIRECTOR
Credential: B.A.,RVT, R NCS T
Phone: 904-737-5792