Provider Demographics
NPI:1205189933
Name:NEUROLOGIC CENTER, INC
Entity Type:Organization
Organization Name:NEUROLOGIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:JUMAO-AS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-847-9773
Mailing Address - Street 1:7400 DISTRICT BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-4817
Mailing Address - Country:US
Mailing Address - Phone:661-847-9773
Mailing Address - Fax:661-847-9776
Practice Address - Street 1:7400 DISTRICT BLVD
Practice Address - Street 2:STE C
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-4817
Practice Address - Country:US
Practice Address - Phone:661-847-9773
Practice Address - Fax:661-847-9776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC433742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC43374OtherCA LICENSE
CAGQ325AMedicare PIN