Basic Information
| Provider Information | |||||||||
| NPI: | 1982066171 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APP NEUROLOGY CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 748157 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900748157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417895250 | ||||||||
| FaxNumber: | 5417895538 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 STATE ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417895791 | ||||||||
| FaxNumber: | 5417895973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2016 | ||||||||
| LastUpdateDate: | 03/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | HOCKING | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CAFO | ||||||||
| AuthorizedOfficialTelephone: | 5417894916 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASANTE PHYSICIAN PARTNERS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
No ID Information.