Provider Demographics
NPI:1619043734
Name:NEUROLOGY MUSCULAR DYSTROPHY AND NEUROPATHY INSTITUTE
Entity Type:Organization
Organization Name:NEUROLOGY MUSCULAR DYSTROPHY AND NEUROPATHY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATAN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:SHAOULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:3102-578-2525
Mailing Address - Street 1:9301 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5424
Mailing Address - Country:US
Mailing Address - Phone:310-278-2525
Mailing Address - Fax:
Practice Address - Street 1:9301 WILSHIRE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5424
Practice Address - Country:US
Practice Address - Phone:310-278-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA724402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A724400Medicaid
CAH60772Medicare UPIN
CA00A724400Medicaid