Marina Center Neurodiagnostics Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

C3298806 Issued in CA

Legal business name

MARINA CENTER NEURODIAGNOSTICS INC

Practice address

3011 Grayson Ave
Venice, CA 90291-4651

Phone

(562) 201-3874

Fax

(866) 441-8248

NPI assigned

May 13, 2014

Organization subpart

No

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

Authorized official

Name

Edwards Michael, MD

Title

Owner

Phone

(562) 201-3874

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1891106712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3011 GRAYSON AVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902914651",
            "telephone_number": "562-201-3874",
            "fax_number": "866-441-8248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3011 GRAYSON AVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902914651",
            "telephone_number": "562-201-3874",
            "fax_number": "866-441-8248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARINA CENTER NEURODIAGNOSTICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-13",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "MICHAEL",
        "authorized_official_first_name": "EDWARDS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-201-3874",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "C3298806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosalie S Maduro
• Renwick Yoshio Maeda, PT MPT OCS GCFP
• Anjali Mahoney, MD MPH
• Brisa Mahoney
• Ana Marin
• Riley Marsh
• Alfonso Martin, BA/BS
• Denise Adeli Martinez
• Michelle Jennifer Martinez
• Rubana Masood, DDS

• General Practice Physician in Venice, CA
• Providers in Venice, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; 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.