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General NPI Number Information
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NPI Number | 1376308981
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Entity Type | Organization
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Legal Business Name | CEP AMERICA - NEUROLOGY PC
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Dates
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Enumeration Date | 02/14/2024
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 1300 N VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-6098
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Country | US
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Telephone | 213-413-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 CUMMINS DR STE D
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City | MODESTO
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State | CA
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Zip | 95358-6411
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Country | US
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Telephone | 510-851-7501
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Fax |
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Authorized Official
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Title or Position | VP AND SECRETARY
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Name | DAVID BIRDSALL
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Credential | MD
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Telephone | 510-350-2600
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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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