MEDICARE: JAMES ENGALL PH.D.

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist		CA

General Provider Information

NPI Number	:	1386040012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ENGALL PH.D.

Provider Business Mailing Address
First Line	:	3702 RUFFIN RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1893
Country	:	US
Telephone Number	:	858-279-6722
Fax Number	:

Provider Business Practice Location Address
First Line	:	3702 RUFFIN RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1893
Country	:	US
Telephone Number	:	858-279-6722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2014
Last Update Date	:	11/06/2014

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