Provider Demographics
NPI:1104204783
Name:ADVANCED NEURO MANAGEMENT SERVICES, INC.
Entity Type:Organization
Organization Name:ADVANCED NEURO MANAGEMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-908-5850
Mailing Address - Street 1:PO BOX 941715
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93094-1715
Mailing Address - Country:US
Mailing Address - Phone:310-908-5850
Mailing Address - Fax:
Practice Address - Street 1:2655 1ST ST
Practice Address - Street 2:SUITE 250
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1547
Practice Address - Country:US
Practice Address - Phone:310-908-5850
Practice Address - Fax:303-922-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1299532084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty