Provider Demographics
NPI:1790083723
Name:QUANTUM NEUROMONITORING CORPORATION
Entity Type:Organization
Organization Name:QUANTUM NEUROMONITORING CORPORATION
Other - Org Name:DHIRAJ RAJ JEYANANDARAJAN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DHIRAJ
Authorized Official - Middle Name:RAJ
Authorized Official - Last Name:JEYANANDARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-631-0112
Mailing Address - Street 1:11121 SUN CENTER DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6161
Mailing Address - Country:US
Mailing Address - Phone:916-631-0112
Mailing Address - Fax:916-631-1652
Practice Address - Street 1:11121 SUN CENTER DR
Practice Address - Street 2:SUITE G
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6161
Practice Address - Country:US
Practice Address - Phone:916-631-0112
Practice Address - Fax:916-631-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA912592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154547719OtherNPI