Provider Demographics
NPI:1962435230
Name:NEUROCARE A MEDICAL CORPORATION
Entity type:Organization
Organization Name:NEUROCARE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHOUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-548-4111
Mailing Address - Street 1:14150 CULVER DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0323
Mailing Address - Country:US
Mailing Address - Phone:949-548-4111
Mailing Address - Fax:949-548-9664
Practice Address - Street 1:14150 CULVER DR
Practice Address - Street 2:SUITE 307
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0323
Practice Address - Country:US
Practice Address - Phone:949-548-4111
Practice Address - Fax:949-548-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15799Medicare PIN