Provider Demographics
NPI:1760880371
Name:PACIFIC NEUROPHYSIOLOGICAL SYSTEMS
Entity Type:Organization
Organization Name:PACIFIC NEUROPHYSIOLOGICAL SYSTEMS
Other - Org Name:PNSLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-A
Authorized Official - Phone:415-221-1591
Mailing Address - Street 1:2339 IRVING ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1620
Mailing Address - Country:US
Mailing Address - Phone:415-221-1591
Mailing Address - Fax:415-221-3274
Practice Address - Street 1:2339 IRVING ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1620
Practice Address - Country:US
Practice Address - Phone:415-221-1591
Practice Address - Fax:415-221-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty