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General NPI Number Information
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NPI Number | 1760566400
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Entity Type | Organization
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Legal Business Name | NEUROCENTER FOR PAIN AND TREMOR A MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 1125 S BEVERLY DR STE 610
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City | LOS ANGELES
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State | CA
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Zip | 90035-1182
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Country | US
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Telephone | 310-553-3379
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Fax | 310-847-9714
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Provider Business Mailing Address
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Address Line | 1125 S BEVERLY DR STE.610
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City | LOS ANGELES
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State | CA
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Zip | 90035-1148
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Country | US
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Telephone | 310-553-3379
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Fax | 310-847-9714
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACOB W CHODAKIEWITZ
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Credential | MD
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Telephone | 310-553-3379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A38243
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License Number State | CA
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