Provider Demographics
NPI:1154631505
Name:AMBULATORY NEUROLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:AMBULATORY NEUROLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIBARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-340-9726
Mailing Address - Street 1:PO BOX 28669
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92198-0669
Mailing Address - Country:US
Mailing Address - Phone:888-447-5904
Mailing Address - Fax:866-273-5772
Practice Address - Street 1:8541 S REDWOOD RD
Practice Address - Street 2:STE A1
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9327
Practice Address - Country:US
Practice Address - Phone:801-999-4857
Practice Address - Fax:866-273-5772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBULATORY NEUROLOGICAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-19
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty