Provider Demographics
NPI:1821239252
Name:CALIFORNIA NEUROLOGICAL CENTER, INC.
Entity Type:Organization
Organization Name:CALIFORNIA NEUROLOGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:BANERJEE
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:415-377-2837
Mailing Address - Street 1:1922 GOLDEN SKY CIR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5292
Mailing Address - Country:US
Mailing Address - Phone:415-377-2837
Mailing Address - Fax:650-618-0485
Practice Address - Street 1:227 W JANSS RD STE 135
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1857
Practice Address - Country:US
Practice Address - Phone:415-377-2837
Practice Address - Fax:650-618-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA869562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1926200OtherMEDICARE PTAN