Basic Information
| Provider Information | |||||||||
| NPI: | 1578097945 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROSURGICAL SPINE GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3548 STONEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914035007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188170898 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7230 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | WEST HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913071907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008990101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2017 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | VOKSHOOR | ||||||||
| AuthorizedOfficialFirstName: | AMIR | ||||||||
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| AuthorizedOfficialTitleorPosition: | NEUROSURGEON | ||||||||
| AuthorizedOfficialTelephone: | 8188170898 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AMIR VOKSHOOR MD MEDCORP | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | A078293 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.