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General NPI Number Information
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NPI Number | 1104963834
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Entity Type | Organization
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Legal Business Name | NEUROSURGICAL TRAUMA SERVICES
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 12/31/2009
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Provider Practice Location Address
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Address Line | 1301 SECRET RAVINE PKWY STE 200
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City | ROSEVILLE
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State | CA
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Zip | 95661-3096
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Country | US
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Telephone | 916-771-3393
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2600
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City | GRANITE BAY
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State | CA
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Zip | 95746-2600
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Country | US
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Telephone | 916-771-3393
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BAHRAM CHEHRAZI
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Credential | MD
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Telephone | 916-771-3393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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