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General NPI Number Information
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NPI Number | 1407026354
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Entity Type | Organization
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Legal Business Name | INFONEURO GROUP, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 415 N CRESCENT DR STE 220
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-6810
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Country | US
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Telephone | 909-567-0600
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Fax | 909-597-0655
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Provider Business Mailing Address
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Address Line | PO BOX 12843
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City | MARINA DEL REY
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State | CA
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Zip | 90295-3843
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Country | US
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Telephone | 909-597-0600
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Fax | 909-597-0655
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | GIL A GALLIGUEZ
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Credential |
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Telephone | 909-597-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A72928
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License Number State | CA
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