Provider Demographics
NPI:1144564477
Name:QUALITY NEURO SUPPLY LLC
Entity Type:Organization
Organization Name:QUALITY NEURO SUPPLY LLC
Other - Org Name:QUALITY NEUROMONITORING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-600-1572
Mailing Address - Street 1:PO BOX 2864
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92814-0864
Mailing Address - Country:US
Mailing Address - Phone:818-600-1572
Mailing Address - Fax:877-625-7254
Practice Address - Street 1:2201 W BROADWAY
Practice Address - Street 2:SUITE B201
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-2374
Practice Address - Country:US
Practice Address - Phone:818-600-1572
Practice Address - Fax:877-625-7254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME942182084N0600X
TX2124246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty