MEDICARE: WEST COAST NEURO

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

General Provider Information

NPI Number	:	1942653258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST COAST NEURO

Provider Business Mailing Address
First Line	:	PO BOX 103631
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91189-6020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3863 SHERWOOD PL
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-4607
Country	:	US
Telephone Number	:	310-953-9759
Fax Number	:	213-785-8864

Authorized Official
Title or Position	:	CEO
Name	:	MR. RYAN FLORES
Credential	:
Telephone Number	:	310-953-9759

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	02/06/2024

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Directions to “WEST COAST NEURO ” Practice Location

Language	Start Address	Practice Location

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