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General NPI Number Information
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NPI Number | 1699014019
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Entity Type | Organization
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Legal Business Name | BASIC ON-CALL, LLC
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 4631 TELLER AVE SUITE 100
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-8105
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Country | US
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Telephone | 949-292-1881
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Fax |
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Provider Business Mailing Address
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Address Line | 6100 CENTER DR SUITE 600
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City | LOS ANGELES
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State | CA
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Zip | 90045-9200
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Country | US
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Telephone | 949-292-1881
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GOWRIHARAN THAIYANANTHAN
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Credential | M.D.
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Telephone | 949-282-1881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | A80845
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | A99924
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License Number State | CA
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