Provider Demographics
NPI:1265486757
Name:SOUTHLAND NEUROLOGIC ASSOCIATES OF ORANGE COUNTY INC
Entity type:Organization
Organization Name:SOUTHLAND NEUROLOGIC ASSOCIATES OF ORANGE COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-430-4513
Mailing Address - Street 1:3747 WORSHAM AVENUE
Mailing Address - Street 2:#100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1774
Mailing Address - Country:US
Mailing Address - Phone:562-430-4513
Mailing Address - Fax:562-430-7718
Practice Address - Street 1:3747 WORSHAM AVENUE
Practice Address - Street 2:#100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1774
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:2006-05-20
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084N0400X, 2085R0202X
CAG203092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1148Medicare ID - Type UnspecifiedGROUP MEDICARE