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General NPI Number Information
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NPI Number | 1548881873
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Entity Type | Organization
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Legal Business Name | FRESNO INSTITUTE OF NEUROSCIENCE, INC
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 1558 E SHADOW CREEK DR
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City | FRESNO
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State | CA
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Zip | 93730-3536
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Country | US
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Telephone | 610-349-0686
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Fax | 151-697-7329
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Provider Business Mailing Address
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Address Line | 1968 S COAST HWY STE 550
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3681
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Country | US
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Telephone | 151-647-8830
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Fax | 151-697-7329
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK STECKER
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Credential | MD
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Telephone | 610-349-0686
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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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