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General NPI Number Information
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NPI Number | 1336354885
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Entity Type | Organization
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Legal Business Name | NEUROBEHAVIORAL MEDICAL GROUP INC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 06/12/2013
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Provider Practice Location Address
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Address Line | 716 YARMOUTH RD STE 203
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City | PALOS VERDES ESTATES
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State | CA
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Zip | 90274-2668
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Country | US
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Telephone | 310-377-3070
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Fax |
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Provider Business Mailing Address
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Address Line | 716 YARMOUTH RD STE 203
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City | PALOS VERDES ESTATES
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State | CA
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Zip | 90274-2668
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Country | US
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Telephone | 310-377-3070
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | PAM CALDERON
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Credential |
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Telephone | 310-343-8884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY10353
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | CA
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