Provider Demographics
NPI:1407265259
Name:AZLE NEUROMONITORING LLC
Entity Type:Organization
Organization Name:AZLE NEUROMONITORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTO
Authorized Official - Middle Name:CEZAR
Authorized Official - Last Name:LASTIMOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-908-8124
Mailing Address - Street 1:1244 BOLING RANCH ROAD N
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020
Mailing Address - Country:US
Mailing Address - Phone:817-908-8124
Mailing Address - Fax:817-885-7339
Practice Address - Street 1:1244 BOLING RANCH ROAD N
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020
Practice Address - Country:US
Practice Address - Phone:817-908-8124
Practice Address - Fax:817-885-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8651207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty