Provider Demographics
NPI:1043621394
Name:MOBILE NEUROLOGY OF SAN DIEGO
Entity Type:Organization
Organization Name:MOBILE NEUROLOGY OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ER-KAI
Authorized Official - Middle Name:
Authorized Official - Last Name:GAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-667-4545
Mailing Address - Street 1:8851 CENTER DR
Mailing Address - Street 2:SUITE 603
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3017
Mailing Address - Country:US
Mailing Address - Phone:619-667-4545
Mailing Address - Fax:
Practice Address - Street 1:8851 CENTER DR
Practice Address - Street 2:SUITE 603
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3017
Practice Address - Country:US
Practice Address - Phone:619-667-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA716592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty