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NPI Code Detail

MEDICARE: NEUROLOGY DOCTORS OF CALIFORNIA, INC.

MEDICARE: NEUROLOGY DOCTORS OF CALIFORNIA, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CK6215OTHERCARAILROAD MEDICARE NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1GR0086520OTHERCAMEDI-CAL
3ZZZ04904ZOTHERCABLUE SHIELD OF CA.

General Provider Information

NPI Number : 1104831965
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUROLOGY DOCTORS OF CALIFORNIA, INC.
Provider Business Mailing Address
First Line : 2621 S BRISTOL ST
Second Line : # 105
City : SANTA ANA
State : CA
Zip : 92704-5766
Country : US
Telephone Number : 714-540-1840
Fax Number : 714-540-2319
Provider Business Practice Location Address
First Line : 2621 S BRISTOL ST
Second Line : # 105
City : SANTA ANA
State : CA
Zip : 92704-5766
Country : US
Telephone Number : 714-540-1840
Fax Number : 714-540-2319
Authorized Official
Title or Position : PRESIDENT
Name : DR. M. MICHAEL MAHDAD
Credential : M.D.
Telephone Number : 714-546-5505
Provider Enumeration Date : 07/30/2006
Last Update Date : 10/06/2008

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