=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811368178
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REM NEURODIAGNOSTICS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2015
-----------------------------------------------------
Last Update Date | 10/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4214 GREEN RIVER RD SUITE NUMBER 200
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92880-1669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-874-6336
-----------------------------------------------------
Fax | 877-874-6335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 MUSICK
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-874-6336
-----------------------------------------------------
Fax | 877-874-6335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | FARSHAD FIROUZNAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 877-874-6336
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------