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General NPI Number Information
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NPI Number | 1336749100
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Entity Type | Organization
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Legal Business Name | ADULT NEUROLOGY SPECIALISTS INC
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 729 SUNRISE AVE STE 616
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City | ROSEVILLE
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State | CA
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Zip | 95661-4548
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Country | US
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Telephone | 954-732-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 729 SUNRISE AVE STE 616
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City | ROSEVILLE
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State | CA
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Zip | 95661-4548
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Country | US
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Telephone | 954-732-1211
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KAUROON MAZDAK DARYA
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Credential | DO
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Telephone | 408-679-9807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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