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General NPI Number Information
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NPI Number | 1750461570
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Entity Type | Organization
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Legal Business Name | HUMBOLDT NEUROLOGICAL MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 2828 ONEIL LANE
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City | EUREKA
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State | CA
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Zip | 95503-4870
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Country | US
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Telephone | 707-443-9385
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Fax | 707-443-0258
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Provider Business Mailing Address
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Address Line | 2828 ONEIL LANE
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City | EUREKA
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State | CA
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Zip | 95503-4870
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Country | US
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Telephone | 707-443-9385
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Fax | 707-443-0258
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | KURT MARVIN OSBORN
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Credential | MD
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Telephone | 707-443-9385
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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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