Provider Demographics
NPI:1821400383
Name:PROFESSIONAL NEUROMONITORING CORPORATION
Entity Type:Organization
Organization Name:PROFESSIONAL NEUROMONITORING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:949-336-5112
Mailing Address - Street 1:460 GODDARD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4610
Mailing Address - Country:US
Mailing Address - Phone:949-336-5112
Mailing Address - Fax:949-336-5113
Practice Address - Street 1:460 GODDARD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4610
Practice Address - Country:US
Practice Address - Phone:949-336-5112
Practice Address - Fax:949-336-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91259282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital