Provider Demographics
NPI:1073654604
Name:LA JOLLA NEUROSURGICAL ASSOCIATES A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LA JOLLA NEUROSURGICAL ASSOCIATES A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:COUFAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:858-677-1755
Mailing Address - Street 1:9834 GENESEE AVE
Mailing Address - Street 2:SUITE #411
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1223
Mailing Address - Country:US
Mailing Address - Phone:858-677-1755
Mailing Address - Fax:858-677-1771
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:SUITE #411
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1223
Practice Address - Country:US
Practice Address - Phone:858-677-1755
Practice Address - Fax:858-677-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5918840001OtherPTAN
W16374Medicare ID - Type Unspecified
CAG72471Medicare UPIN
CA5918840001OtherPTAN