Provider Demographics
NPI:1215145115
Name:WASHINGTON NEURO DIAGNOSTIC'S INC
Entity type:Organization
Organization Name:WASHINGTON NEURO DIAGNOSTIC'S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-425-7374
Mailing Address - Street 1:11109 HARTSOOK ST
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3830
Mailing Address - Country:US
Mailing Address - Phone:818-425-7374
Mailing Address - Fax:818-762-0968
Practice Address - Street 1:409 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3140
Practice Address - Country:US
Practice Address - Phone:818-425-7374
Practice Address - Fax:818-762-0968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0210400OtherPROVIDER DEPT OF LNI