Provider Demographics
NPI:1487338828
Name:NEUROMED CLINIC
Entity type:Organization
Organization Name:NEUROMED CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL ADVISOR
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:DJALILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-550-0080
Mailing Address - Street 1:2102 BUSINESS CENTER DR STE 130
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1001
Mailing Address - Country:US
Mailing Address - Phone:888-226-6330
Mailing Address - Fax:
Practice Address - Street 1:2102 BUSINESS CENTER DR STE 130
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1001
Practice Address - Country:US
Practice Address - Phone:888-226-6330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty