Healthcare Provider Details

I. General information

NPI: 1215145115
Provider Name (Legal Business Name): WASHINGTON NEURO DIAGNOSTIC'S INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S 12TH AVE
YAKIMA WA
98902-3140
US

IV. Provider business mailing address

11109 HARTSOOK ST
N HOLLYWOOD CA
91601-3830
US

V. Phone/Fax

Practice location:
  • Phone: 818-425-7374
  • Fax: 818-762-0968
Mailing address:
  • Phone: 818-425-7374
  • Fax: 818-762-0968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: MS. HEATHER FERMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 818-425-7374