Provider Demographics
NPI:1801222039
Name:MP ADVANCED NEUROLOGY, INC.
Entity type:Organization
Organization Name:MP ADVANCED NEUROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAREMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-809-5995
Mailing Address - Street 1:PO BOX 3524
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3524
Mailing Address - Country:US
Mailing Address - Phone:310-809-5995
Mailing Address - Fax:949-764-9233
Practice Address - Street 1:19582 BEACH BLVD STE 270
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5924
Practice Address - Country:US
Practice Address - Phone:714-718-0988
Practice Address - Fax:949-669-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1026032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD0118ZMedicare PIN