Provider Demographics
NPI:1265986145
Name:OC NEUROLOGY CLINIC, INC.
Entity type:Organization
Organization Name:OC NEUROLOGY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NASER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELBALALESY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-837-7322
Mailing Address - Street 1:139 VIA ATHENA
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1612
Mailing Address - Country:US
Mailing Address - Phone:949-837-7322
Mailing Address - Fax:714-848-3301
Practice Address - Street 1:17822 BEACH BLVD
Practice Address - Street 2:# 374
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7101
Practice Address - Country:US
Practice Address - Phone:714-848-3333
Practice Address - Fax:714-848-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73709261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A737090OtherMEDICAL/MEDICARE
CAH77977Medicare UPIN