Provider Demographics
NPI:1033653571
Name:CENTER OF EXCELLENCE IN PEDIATRIC NEUROLOGY MEDICAL INC
Entity Type:Organization
Organization Name:CENTER OF EXCELLENCE IN PEDIATRIC NEUROLOGY MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHUTOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-836-5800
Mailing Address - Street 1:5800 STANFORD RANCH RD
Mailing Address - Street 2:BUILDING 800
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4387
Mailing Address - Country:US
Mailing Address - Phone:916-836-8500
Mailing Address - Fax:916-758-2924
Practice Address - Street 1:5800 STANFORD RANCH RD
Practice Address - Street 2:BUILDING 800
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4387
Practice Address - Country:US
Practice Address - Phone:916-836-8500
Practice Address - Fax:916-758-2924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty