Provider Demographics
NPI:1639306780
Name:CALIFORNIA NEUROMEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:CALIFORNIA NEUROMEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSABEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS PHARM
Authorized Official - Phone:310-428-2244
Mailing Address - Street 1:3201 OVERLAND AVE
Mailing Address - Street 2:STE 9130
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4574
Mailing Address - Country:US
Mailing Address - Phone:909-557-8727
Mailing Address - Fax:310-680-0305
Practice Address - Street 1:511 BROOKSIDE AVE
Practice Address - Street 2:SUITE # 102
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4611
Practice Address - Country:US
Practice Address - Phone:909-557-8727
Practice Address - Fax:909-792-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG641572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BD793Medicare PIN
CA00G641570Medicare PIN