MEDICARE: NEUROLOGIC CENTER, 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
1	2084N0400X	Neurology Physician	C43374	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C43374	OTHER	CA	CA LICENSE

General Provider Information

NPI Number	:	1205189933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGIC CENTER, INC

Provider Business Mailing Address
First Line	:	7400 DISTRICT BLVD
Second Line	:	STE C
City	:	BAKERSFIELD
State	:	CA
Zip	:	93313-4817
Country	:	US
Telephone Number	:	661-847-9773
Fax Number	:	661-847-9776

Provider Business Practice Location Address
First Line	:	7400 DISTRICT BLVD
Second Line	:	STE C
City	:	BAKERSFIELD
State	:	CA
Zip	:	93313-4817
Country	:	US
Telephone Number	:	661-847-9773
Fax Number	:	661-847-9776

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ASELA P. JUMAO-AS
Credential	:	MD
Telephone Number	:	661-847-9773

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	02/27/2014

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Directions to “NEUROLOGIC CENTER, INC ” Practice Location

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