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General NPI Number Information
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NPI Number | 1659072106
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Entity Type | Organization
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Legal Business Name | NEURO FITNESS MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 18726 S WESTERN AVE STE 409
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City | GARDENA
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State | CA
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Zip | 90248-3858
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Country | US
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Telephone | 310-819-8582
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Fax |
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Provider Business Mailing Address
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Address Line | 18726 S WESTERN AVE STE 409
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City | GARDENA
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State | CA
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Zip | 90248-3858
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Country | US
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Telephone | 310-819-8582
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAUL JOSEPH SLISKOVICH
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Credential | MD
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Telephone | 310-819-8582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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