Provider Demographics
NPI:1598262552
Name:EEG INFO
Entity type:Organization
Organization Name:EEG INFO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:R
Authorized Official - Last Name:OTHMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-456-5965
Mailing Address - Street 1:6400 CANOGA AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367
Mailing Address - Country:US
Mailing Address - Phone:818-456-5975
Mailing Address - Fax:818-373-1331
Practice Address - Street 1:6400 CANOGA AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367
Practice Address - Country:US
Practice Address - Phone:818-456-5975
Practice Address - Fax:818-373-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty