Provider Demographics
NPI:1407236466
Name:SOUTHERN CALIFORNIA NEUROLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA NEUROLOGY MEDICAL GROUP, INC.
Other - Org Name:SOUTHERN CALIFORNIA NEUROLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINAZAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-535-9344
Mailing Address - Street 1:416 E. GLENDALE ST., SUITE A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:416 E COLORADO ST STE A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5100
Practice Address - Country:US
Practice Address - Phone:626-535-9344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN CALIFORNIA NEUROLOGY CONSULTANTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty