Provider Demographics
NPI:1689327603
Name:NU WAVE NDT INC
Entity Type:Organization
Organization Name:NU WAVE NDT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTRAOPERATIVENEUROMONITORIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ROCIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BAENA
Authorized Official - Suffix:
Authorized Official - Credentials:R EEG, CNIM, BS
Authorized Official - Phone:626-224-1287
Mailing Address - Street 1:1108 N ANGELENO AVE # 911
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-1913
Mailing Address - Country:US
Mailing Address - Phone:626-224-1287
Mailing Address - Fax:
Practice Address - Street 1:1720 E. CESAR CHAVEZ AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-268-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NU WAVE NDT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17001125572OtherNPI 1
CA17001125572OtherNPI