Provider Demographics
NPI:1033500145
Name:PREMIER BRAIN AND SPINE INSTITUTE
Entity Type:Organization
Organization Name:PREMIER BRAIN AND SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTAMZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-540-6861
Mailing Address - Street 1:800 POLLARD RD
Mailing Address - Street 2:BUILDING A
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1415
Mailing Address - Country:US
Mailing Address - Phone:408-540-6861
Mailing Address - Fax:408-540-6865
Practice Address - Street 1:800 POLLARD RD
Practice Address - Street 2:BUILDING A
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1415
Practice Address - Country:US
Practice Address - Phone:408-540-6861
Practice Address - Fax:408-540-6865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty