Provider Demographics
NPI:1831104629
Name:SANTA CLARITA NEUROLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SANTA CLARITA NEUROLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-255-5444
Mailing Address - Street 1:23823 VALENCIA BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-9509
Mailing Address - Country:US
Mailing Address - Phone:661-255-5444
Mailing Address - Fax:661-255-8447
Practice Address - Street 1:23823 VALENCIA BLVD STE 115
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-9509
Practice Address - Country:US
Practice Address - Phone:661-255-5444
Practice Address - Fax:661-255-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG452332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0056130Medicaid
CAF18549Medicare UPIN
CAW11752Medicare ID - Type Unspecified