Provider Demographics
NPI:1356829634
Name:VIGILANT NEUROMONITORING LLC
Entity type:Organization
Organization Name:VIGILANT NEUROMONITORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-322-1344
Mailing Address - Street 1:PO BOX 103907
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-0183
Mailing Address - Country:US
Mailing Address - Phone:714-322-1344
Mailing Address - Fax:
Practice Address - Street 1:20331 IRVINE AVE STE E2
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0223
Practice Address - Country:US
Practice Address - Phone:714-322-1344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty