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General NPI Number Information
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NPI Number | 1932085305
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Entity Type | Organization
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Legal Business Name | GAMMA NEURO DIAGNOSTICS INC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 510 SUPERIOR AVE STE 200A
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3664
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Country | US
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Telephone | 949-764-8430
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Fax | 310-691-1394
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Provider Business Mailing Address
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Address Line | PO BOX 2277
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City | VENICE
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State | CA
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Zip | 90294-2277
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL VITANTONIO
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Credential |
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Telephone | 310-923-1437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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