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General NPI Number Information
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NPI Number | 1689856841
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Entity Type | Organization
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Legal Business Name | NEUROLOGICAL INSTITUTE OF YUMA
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 2281 W 24TH ST STE 8
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City | YUMA
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State | AZ
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Zip | 85364-6197
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Country | US
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Telephone | 928-314-3535
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Fax | 928-314-3939
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Provider Business Mailing Address
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Address Line | PO BOX 4818
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City | YUMA
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State | AZ
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Zip | 85366-4818
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Country | US
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Telephone | 928-314-3535
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Fax | 928-314-3939
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. KAMAL RASTOGI
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Credential | M.D.
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Telephone | 928-314-3535
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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 | 33164
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License Number State | AZ
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