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General NPI Number Information
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NPI Number | 1811023443
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Entity Type | Organization
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Legal Business Name | PACIFIC NEUROLOGY CONSULTANTS, INC.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 3191 OAK KNOLL DR
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-4516
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Country | US
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Telephone | 562-365-3022
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Fax | 888-596-7302
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Provider Business Mailing Address
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Address Line | PO BOX 6007
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City | LONG BEACH
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State | CA
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Zip | 90806-0007
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Country | US
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Telephone | 562-365-3022
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Fax | 888-596-7302
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHAN VENKATARATNA TADIKONDA
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Credential | M.D.
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Telephone | 562-365-3022
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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 | A85738
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License Number State | CA
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