Provider Demographics
NPI:1043456742
Name:CALIFORNIA NEUROMEDICAL SERVICES
Entity Type:Organization
Organization Name:CALIFORNIA NEUROMEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSABEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-428-2244
Mailing Address - Street 1:511 BROOKSIDE AVE
Mailing Address - Street 2:STE. 102
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4611
Mailing Address - Country:US
Mailing Address - Phone:909-557-8727
Mailing Address - Fax:909-335-8514
Practice Address - Street 1:301 N PRAIRIE AVE
Practice Address - Street 2:STE.315
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4507
Practice Address - Country:US
Practice Address - Phone:310-680-0304
Practice Address - Fax:310-680-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG641572084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180519600OtherOWCP
CA000G641570OtherBLUE SHIELD
CA00G641570Medicaid
CARR1022OtherRAILROAD MEDICARE
CAP00011946OtherRAILROAD MEDICARE
CA000G641570OtherBLUE SHIELD
CABD793Medicare PIN
CAG64157Medicare PIN
CA180519600OtherOWCP