MEDICARE: NEUROGUARD PRO

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	2084N0600X	Clinical Neurophysiology Physician
2	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1518527613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROGUARD PRO

Provider Business Mailing Address
First Line	:	PO BOX 1013
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1013
Country	:	US
Telephone Number	:	949-338-5939
Fax Number	:

Provider Business Practice Location Address
First Line	:	795 S QUAIL CIR
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-4427
Country	:	US
Telephone Number	:	949-338-5939
Fax Number	:

Authorized Official
Title or Position	:	BILLING OFFICE MANAGER
Name	:	SHERRI BURNINGHAM
Credential	:
Telephone Number	:	707-953-0956

Provider Enumeration Date	:	06/19/2019
Last Update Date	:	01/15/2026

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