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General NPI Number Information
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NPI Number | 1144340662
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Entity Type | Organization
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Legal Business Name | ENCEPHALOGIC MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/01/2013
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Provider Practice Location Address
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Address Line | 1701 SOLAR DR SUITE 140
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City | OXNARD
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State | CA
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Zip | 93030-0134
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Country | US
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Telephone | 805-278-4148
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Fax | 805-278-4634
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Provider Business Mailing Address
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Address Line | 1701 SOLAR DR SUITE 140
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City | OXNARD
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State | CA
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Zip | 93030-0134
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Country | US
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Telephone | 805-278-4148
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Fax | 805-278-4634
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Authorized Official
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Title or Position | PRESIDENT - MEDICAL DIRECTOR
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Name | DR. JAMES P. SUTTON
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Credential | M.D.
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Telephone | 805-278-4148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State | CA
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