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General NPI Number Information
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NPI Number | 1790496560
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Entity Type | Organization
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Legal Business Name | LIFETIME NEURODEVELOPMENTAL CARE INC
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 4212 GRIMES PL
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City | ENCINO
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State | CA
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Zip | 91316-4358
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Country | US
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Telephone | 415-952-6095
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Fax |
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Provider Business Mailing Address
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Address Line | 4212 GRIMES PL
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City | ENCINO
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State | CA
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Zip | 91316-4358
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Country | US
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Telephone | 415-952-6095
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Fax |
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Authorized Official
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Title or Position | CFO AND PHYSICIAN
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Name | DR. MARY STEELE
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Credential | MD
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Telephone | 415-952-6095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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