=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205260270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED PSYCHIATRIC TMS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2013
-----------------------------------------------------
Last Update Date | 08/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2650 JONES WAY SUITE 27B
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065-1203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-582-4995
-----------------------------------------------------
Fax | 805-582-4955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2650 JONES WAY SUITE 27B
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065-1203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-582-4995
-----------------------------------------------------
Fax | 805-582-4955
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. DAVID CYRUS GUDEMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 805-582-4995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------