Provider Demographics
NPI:1194064360
Name:NEURO DYNAMICS
Entity type:Organization
Organization Name:NEURO DYNAMICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FEDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-497-3168
Mailing Address - Street 1:16837 LOS ALIMOS ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5054
Mailing Address - Country:US
Mailing Address - Phone:310-497-3168
Mailing Address - Fax:818-955-5788
Practice Address - Street 1:16837 LOS ALIMOS ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5054
Practice Address - Country:US
Practice Address - Phone:310-497-3168
Practice Address - Fax:818-955-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty