Provider Demographics
NPI:1922028539
Name:HIGH DESERT NEURO-DIAGNOSTIC MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:HIGH DESERT NEURO-DIAGNOSTIC MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANMOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAYYAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-946-3876
Mailing Address - Street 1:18523 CORWIN ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2338
Mailing Address - Country:US
Mailing Address - Phone:760-946-3876
Mailing Address - Fax:760-242-1936
Practice Address - Street 1:18523 CORWIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2338
Practice Address - Country:US
Practice Address - Phone:760-946-3876
Practice Address - Fax:760-242-1936
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGH DESERT NEURO-DIAGNOSTIC MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27198ZMedicare UPIN
CAZZZ271987Medicare ID - Type Unspecified