Provider Demographics
NPI:1841408424
Name:PROFESSIONAL NEUROLOGICAL CARE
Entity Type:Organization
Organization Name:PROFESSIONAL NEUROLOGICAL CARE
Other - Org Name:PROFESSIONAL NEUROL CARE MED CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-939-1689
Mailing Address - Street 1:3831 HUGHES AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2751
Mailing Address - Country:US
Mailing Address - Phone:323-939-1689
Mailing Address - Fax:323-939-7084
Practice Address - Street 1:6221 WILSHIRE BLVD
Practice Address - Street 2:SUITE 509
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5201
Practice Address - Country:US
Practice Address - Phone:323-939-1689
Practice Address - Fax:323-939-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty