ST. MICHAEL'S NEUROLOGY MEDICAL CORP NPI 1942334958

NPI Information

NPI: 1942334958
Provider Name: ST. MICHAEL'S NEUROLOGY MEDICAL CORP
Classification: Psychiatry & Neurology - 2084N0400X
Entity Type: Organization

Specialization: Neurology

Address:
1141 W REDONDO BEACH BLVD
SUITE 207
GARDENA, CA
ZIP 90247
Phone: (310) 225-5599
Get Directions

ST. MICHAEL'S NEUROLOGY MEDICAL CORP is a neurology psychiatry neurology in Gardena, CA. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. ST. MICHAEL'S NEUROLOGY MEDICAL CORP NPI is 1942334958. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1141 W REDONDO BEACH BLVD
SUITE 207
GARDENA, CA
ZIP 90247-586
Phone: (310) 225-5599
Fax: (310) 225-5660

The provider's authorized official is Sherif A Dimyan .
The authorized official title is President and has the following contact phone number (310) 225-5599.

The enumeration date for this NPI number is 3/15/2007 and was last updated on 3/10/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	204D00000X	Neuromusculoskeletal Medicine & OMM		20A6410	CALIFORNIA	No
2	2084N0600X	Psychiatry & Neurology	Clinical Neurophysiology	20A6410	CALIFORNIA	No
3	2084P2900X	Psychiatry & Neurology	Pain Medicine	20A6410	CALIFORNIA	No
4	2084S0012X	Psychiatry & Neurology	Sleep Medicine	20A6410	CALIFORNIA	No
5	2084V0102X	Psychiatry & Neurology	Vascular Neurology	20A6410	CALIFORNIA	No
6	2084N0400X	Psychiatry & Neurology	Neurology	20A6140	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00AX6461	MEDICAID	CALIFORNIA
2	W17937	MEDICARE PIN	CALIFORNIA
3	F76511	MEDICARE UPIN	CALIFORNIA
4	20A6410	OTHER	CALIFORNIA	MEDICAL LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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