Provider Demographics
NPI:1386366755
Name:NEUROTREE
Entity type:Organization
Organization Name:NEUROTREE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ESRAELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-387-6806
Mailing Address - Street 1:530 S LAKE AVE # 149
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3515
Mailing Address - Country:US
Mailing Address - Phone:424-387-6806
Mailing Address - Fax:
Practice Address - Street 1:3707 E SOUTHERN AVE
Practice Address - Street 2:FLOORS 1 AND 2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2569
Practice Address - Country:US
Practice Address - Phone:424-387-6806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty