Provider Demographics
NPI:1639452634
Name:AMBULATORY NEUROLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:AMBULATORY NEUROLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIBARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-340-9726
Mailing Address - Street 1:PO BOX 28669
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92198-0669
Mailing Address - Country:US
Mailing Address - Phone:888-447-5904
Mailing Address - Fax:866-273-5772
Practice Address - Street 1:3847 TEAYS VALLEY RD
Practice Address - Street 2:STE E
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9622
Practice Address - Country:US
Practice Address - Phone:304-250-9177
Practice Address - Fax:866-273-5772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBULATORY NEUROLOGICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-26
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Single Specialty