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General NPI Number Information
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NPI Number | 1376857789
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Entity Type | Organization
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Legal Business Name | PRECISION NEURODIAGNOSTICS
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 6 WHITESANDS DR
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City | NEWPORT COAST
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State | CA
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Zip | 92657-1059
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Country | US
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Telephone | 949-554-4989
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Fax |
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Provider Business Mailing Address
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Address Line | 6 WHITESANDS DR
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City | NEWPORT COAST
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State | CA
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Zip | 92657-1059
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Country | US
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Telephone | 949-554-4989
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFF ALTMAN
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Credential | MD
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Telephone | 949-554-4989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A79570
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License Number State | CA
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