MEDICARE: PAC NEURO 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	207T00000X	Neurological Surgery Physician		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700821915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAC NEURO INC

Provider Business Mailing Address
First Line	:	3590 CAMINO DEL RIO NO.
Second Line	:	SUITE# 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1716
Country	:	US
Telephone Number	:	619-810-1010
Fax Number	:	619-810-1011

Provider Business Practice Location Address
First Line	:	3590 CAMINO DEL RIO NO.
Second Line	:	SUITE# 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1716
Country	:	US
Telephone Number	:	619-810-1010
Fax Number	:	619-810-1011

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANJAY GHOSH
Credential	:	M.D.
Telephone Number	:	619-810-1010

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/21/2022

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Directions to “PAC NEURO INC ” Practice Location

Language	Start Address	Practice Location

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