Provider Demographics
NPI:1659992527
Name:SOUTH BAY NEUROLOGY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SOUTH BAY NEUROLOGY MEDICAL CORPORATION
Other - Org Name:SOUTH BAY NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAZILA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-748-8363
Mailing Address - Street 1:2325 PALOS VERDES DR W STE 220
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2777
Mailing Address - Country:US
Mailing Address - Phone:310-748-8363
Mailing Address - Fax:
Practice Address - Street 1:3655 LOMITA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-1919
Practice Address - Country:US
Practice Address - Phone:424-383-1045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-02
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty