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General NPI Number Information
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NPI Number | 1265661540
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Entity Type | Organization
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Legal Business Name | SOUTH BAY NEUROLOGICAL DIAGNOSTIC CENTER, INC
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 13252 HAWTHORNE BLVD SUITE 100
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City | HAWTHORNE
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State | CA
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Zip | 90250-5816
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Country | US
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Telephone | 310-675-1555
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Fax | 310-675-3355
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Provider Business Mailing Address
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Address Line | 13252 HAWTHORNE BLVD SUITE 100
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City | HAWTHORNE
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State | CA
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Zip | 90250-5816
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Country | US
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Telephone | 310-675-1555
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Fax | 310-675-3355
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DENISE MURIEL MCCARTHY
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Credential |
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Telephone | 310-675-1555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | CA
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