Basic Information
| Provider Information | |||||||||
| NPI: | 1265026371 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC HEALTH NEUROMONITORING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2907 SHELTER ISLAND DR STE 105-612 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921062743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813463480 | ||||||||
| FaxNumber: | 2814624106 | ||||||||
| Practice Location | |||||||||
| Address1: | 1223 20TH PL | ||||||||
| Address2: | |||||||||
| City: | HERMOSA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902543313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813463480 | ||||||||
| FaxNumber: | 2814624106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2021 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | MARTINEZ | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2813463480 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.