La Neuro Medical Group

Primary specialty

Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X

Legal business name

LA NEURO MEDICAL GROUP

Practice address

11843 Dorothy St Apt 2
Los Angeles, CA 90049-4456

Phone

(424) 245-5884

NPI assigned

Jul 17, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Octavio Calderon, CNIM

Title

Partner

Phone

(310) 883-4624

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563321600000",
    "number": "1578116877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11843 DOROTHY ST APT 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900494456",
            "telephone_number": "310-883-4624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11843 DOROTHY ST APT 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900494456",
            "telephone_number": "424-245-5884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA NEURO MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-17",
        "last_updated": "2019-07-17",
        "status": "A",
        "authorized_official_last_name": "CALDERON",
        "authorized_official_first_name": "OCTAVIO",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "310-883-4624",
        "authorized_official_credential": "CNIM"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neurophysiology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Neurophysiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.