Provider Demographics
NPI:1689205049
Name:CALIFORNIA NEUROENDOVASCULAR SPECIALISTS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CALIFORNIA NEUROENDOVASCULAR SPECIALISTS MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WLED
Authorized Official - Middle Name:
Authorized Official - Last Name:WAZNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-522-5304
Mailing Address - Street 1:530 S LAKE AVE # 439
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3515
Mailing Address - Country:US
Mailing Address - Phone:562-522-5304
Mailing Address - Fax:562-491-7985
Practice Address - Street 1:155 N LAKE AVE STE 800
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1857
Practice Address - Country:US
Practice Address - Phone:562-491-9270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical CareGroup - Multi-Specialty