Provider Demographics
NPI:1790076446
Name:SURGICAL NEUROPHYSIOLOGY LLC
Entity Type:Organization
Organization Name:SURGICAL NEUROPHYSIOLOGY LLC
Other - Org Name:SURGICAL NEUROPHYSIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLTANI
Authorized Official - Suffix:
Authorized Official - Credentials:DABNM
Authorized Official - Phone:714-883-7945
Mailing Address - Street 1:12 MAYAPPLE WAY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2714
Mailing Address - Country:US
Mailing Address - Phone:714-883-7945
Mailing Address - Fax:
Practice Address - Street 1:12 MAYAPPLE WAY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2714
Practice Address - Country:US
Practice Address - Phone:714-883-7945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty