Saint Mary Pediatric Neurology Medical Clinic, Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A83604 Issued in CA

Legal business name

SAINT MARY PEDIATRIC NEUROLOGY MEDICAL CLINIC, INC

Practice address

6200 Wilshire Blvd
Suite 1708
Los Angeles, CA 90048-5801

Phone

(323) 939-0008

Fax

(323) 939-0070

NPI assigned

Oct 24, 2006

Organization subpart

No

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

Authorized official

Name

Raafat Iskander, M.D.NPI 1407958234

Title

Owner

Phone

(323) 939-0008

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Saint Mary Ped Neurog Med2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Saint Mary Ped Neurog Med

  • Neurological Surgery Physician
  • Los Angeles, CA
  • NPI 1023281037
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raafat Iskander, M.D.

  • Neurology Physician
  • Los Angeles, CA
  • NPI 1407958234
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871677377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 WILSHIRE BLVD",
            "address_2": "SUITE 1708",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485801",
            "telephone_number": "323-939-0008",
            "fax_number": "323-939-0070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 WILSHIRE BLVD",
            "address_2": "SUITE 1708",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485801",
            "telephone_number": "323-939-0008",
            "fax_number": "323-939-0070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT MARY PEDIATRIC NEUROLOGY MEDICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-08-22",
        "certification_date": "2020-03-20",
        "status": "A",
        "authorized_official_last_name": "ISKANDER",
        "authorized_official_first_name": "RAAFAT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-939-0008",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A83604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A836040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nyka Marie Saint Jean, APRN
• James David Saint John, MD
• Saint Mariam Home Health Care
• Manuel Leonardo Saint Martin, MD
• Saint Mary Ped Neurog Med
• Jessica Dominique Saint-Paul, PA
• Ryushi T. Saisho, MD
• Jessica Elena Saisi, M.S., CCC-SLP
• Ashley Saito
• Elizabeth Kim Saito

• Specialist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.