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General NPI Number Information
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NPI Number | 1992355879
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Entity Type | Organization
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Legal Business Name | CEREBRAL MEDICAL GROUP, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 330 N BRAND BLVD
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City | GLENDALE
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State | CA
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Zip | 91203-2308
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Country | US
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Telephone | 628-263-3658
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Fax | 628-263-3658
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Provider Business Mailing Address
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Address Line | 2093 PHILADELPHIA PIKE # 9898
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City | CLAYMONT
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State | DE
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Zip | 19703-2424
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Country | US
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Telephone | 628-263-3658
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Fax | 628-263-3658
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL BOGGS
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Credential | MD
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Telephone | 415-830-5946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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