Provider Demographics
NPI:1821415878
Name:SOUTHLAND NEUROLOGIC INSTITUTE
Entity Type:Organization
Organization Name:SOUTHLAND NEUROLOGIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LETY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-430-4513
Mailing Address - Street 1:3747 WORSHAM AVE #100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808
Mailing Address - Country:US
Mailing Address - Phone:562-430-4513
Mailing Address - Fax:
Practice Address - Street 1:3747 WORSHAM AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1731
Practice Address - Country:US
Practice Address - Phone:562-430-4513
Practice Address - Fax:562-430-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty