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General NPI Number Information
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NPI Number | 1003847435
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA HEAD PAIN AND NEUROLOGIC INSTITUTE INC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 3555 LOMA VISTA RD #115
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City | VENTURA
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State | CA
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Zip | 93003-3161
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Country | US
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Telephone | 805-648-3158
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Fax | 805-648-2997
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Provider Business Mailing Address
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Address Line | 3555 LOMA VISTA RD STE 115
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City | VENTURA
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State | CA
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Zip | 93003-3161
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Country | US
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Telephone | 805-648-3158
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Fax | 805-648-2997
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOT J RICHARDSON
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Credential | M.D.
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Telephone | 805-648-3158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A60878
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License Number State | CA
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