Basic Information
| Provider Information | |||||||||
| NPI: | 1609948603 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHCOAST NEUROSURGICAL ASSOCIATES A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2752 HARRISON AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955014738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072680190 | ||||||||
| FaxNumber: | 7072693791 | ||||||||
| Practice Location | |||||||||
| Address1: | 2752 HARRISON AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955014738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072680190 | ||||||||
| FaxNumber: | 7072693791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 05/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | ARYANPUR | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7072680190 | ||||||||
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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 | 207T00000X | FNP25793 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | GR0084000 | 01 | MEDI CAL | OTHER |