Provider Demographics
NPI:1972648160
Name:CALIFORNIA NEUROLOGICAL SURGERY
Entity Type:Organization
Organization Name:CALIFORNIA NEUROLOGICAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:FASSNACHT
Authorized Official - Last Name:DOGALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-999-0385
Mailing Address - Street 1:1111 EAST HERNDON AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-435-0770
Mailing Address - Fax:559-435-7126
Practice Address - Street 1:1111 EAST HERNDON AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-435-0770
Practice Address - Fax:559-435-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80285207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G802850Medicaid
A62104Medicare UPIN
CA00G802850Medicaid