Provider Demographics
NPI:1811023443
Name:PACIFIC NEUROLOGY CONSULTANTS, INC.
Entity Type:Organization
Organization Name:PACIFIC NEUROLOGY CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:VENKATARATNA
Authorized Official - Last Name:TADIKONDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-365-3022
Mailing Address - Street 1:PO BOX 6007
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-0007
Mailing Address - Country:US
Mailing Address - Phone:562-365-3022
Mailing Address - Fax:888-596-7302
Practice Address - Street 1:3191 OAK KNOLL DR
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-4516
Practice Address - Country:US
Practice Address - Phone:562-365-3022
Practice Address - Fax:888-596-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA857382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty