=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508217738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 1STOPNEURO, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2016
-----------------------------------------------------
Last Update Date | 06/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2026 VERMILLION OAK ST
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77545-2050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-347-9109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2026 VERMILLION OAK ST
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77545-2050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-347-9109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NEUROPHYSIOLOGY TECHNICIAN
-----------------------------------------------------
Name | ESSIE YAPO
-----------------------------------------------------
Credential | R.EEG.T
-----------------------------------------------------
Telephone | 888-347-9109
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZE0600X
-----------------------------------------------------
Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
-----------------------------------------------------
License Number | 5558
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------