Provider Demographics
NPI:1316025836
Name:NEUROSURGICAL ASSOCIATES OF LOS ANGELES, INC.
Entity Type:Organization
Organization Name:NEUROSURGICAL ASSOCIATES OF LOS ANGELES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-799-2542
Mailing Address - Street 1:23929 MCBEAN PKWY STE 215
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4468
Mailing Address - Country:US
Mailing Address - Phone:661-799-2542
Mailing Address - Fax:661-253-0248
Practice Address - Street 1:23929 MCBEAN PKWY STE 215
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4468
Practice Address - Country:US
Practice Address - Phone:661-799-2542
Practice Address - Fax:661-253-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP33943207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19377Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER