=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134549975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEUROLOGY FIRST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2014
-----------------------------------------------------
Last Update Date | 02/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 838 NORDAHL RD STE 310
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92069-3599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 442-999-5977
-----------------------------------------------------
Fax | 442-999-5914
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 838 NORDAHL RD STE 310
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92069-3599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 442-999-5977
-----------------------------------------------------
Fax | 442-999-5914
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | AZIZ NOOR ANDER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 760-580-1018
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | A118000
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------