Provider Demographics
NPI:1336281625
Name:PACIFIC CENTER FOR NEUROLOGICAL DISEASE INC
Entity type:Organization
Organization Name:PACIFIC CENTER FOR NEUROLOGICAL DISEASE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:JYY
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-674-1289
Mailing Address - Street 1:15708 POMERADO RD STE 103
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2035
Mailing Address - Country:US
Mailing Address - Phone:858-674-1289
Mailing Address - Fax:858-726-6221
Practice Address - Street 1:15644 POMERADO RD 401
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:858-485-5301
Practice Address - Fax:760-745-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W19438Medicare ID - Type Unspecified