Provider Demographics
NPI:1710019039
Name:COASTAL NEUROLOGICAL MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:COASTAL NEUROLOGICAL MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:F
Authorized Official - Last Name:ARMANIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-984-8882
Mailing Address - Street 1:264 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE #1149
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3302
Mailing Address - Country:US
Mailing Address - Phone:818-984-8882
Mailing Address - Fax:818-898-3956
Practice Address - Street 1:418 SAN FERNANDO MISSION BLVD
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3530
Practice Address - Country:US
Practice Address - Phone:818-984-8882
Practice Address - Fax:818-898-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72796174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16827Medicare ID - Type Unspecified
CAH98258Medicare UPIN