Basic Information
| Provider Information | |||||||||
| NPI: | 1073092227 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEURON MONITORING PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 BRIGMORE AISLE | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926035733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109231664 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1120 W LA VETA AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145981745 | ||||||||
| FaxNumber: | 7149419539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2018 | ||||||||
| LastUpdateDate: | 08/08/2018 | ||||||||
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| AuthorizedOfficialLastName: | CHANG | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3109231664 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081N0008X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Neuromuscular Medicine |
ID Information
| ID | Type | State | Issuer | Description | A104168 | 01 | CA | MEDICAL LICENSE | OTHER |