Healthcare Provider Details

I. General information

NPI: 1659765204
Provider Name (Legal Business Name): NEUROMONITORING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2015
Last Update Date: 02/02/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 W CHARLESTON BLVD # 2-641
LAS VEGAS NV
89117-7528
US

IV. Provider business mailing address

DEPT 880257 PO BOX 29650
PHOENIX AZ
85038-9650
US

V. Phone/Fax

Practice location:
  • Phone: 855-864-4322
  • Fax:
Mailing address:
  • Phone: 855-864-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: NICK LUEKENGA
Title or Position: PRESIDENT
Credential:
Phone: 855-864-4322