Provider Demographics
NPI:1619224177
Name:CALIFORNIA NEUROLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:CALIFORNIA NEUROLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-894-3111
Mailing Address - Street 1:1158 26TH ST
Mailing Address - Street 2:STE 504
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4698
Mailing Address - Country:US
Mailing Address - Phone:818-894-3111
Mailing Address - Fax:818-894-3133
Practice Address - Street 1:8780 VAN NUYS BLVD
Practice Address - Street 2:STE B
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2412
Practice Address - Country:US
Practice Address - Phone:818-894-3111
Practice Address - Fax:818-894-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA21993OtherSTATE OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS