Basic Information
| Provider Information | |||||||||
| NPI: | 1154864874 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR NEUROHEALTH INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KAIZEN BRAIN CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4180 LA JOLLA VILLAGE DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662772659 | ||||||||
| FaxNumber: | 8587792511 | ||||||||
| Practice Location | |||||||||
| Address1: | 4180 LA JOLLA VILLAGE DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662772659 | ||||||||
| FaxNumber: | 8587792511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2016 | ||||||||
| LastUpdateDate: | 08/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | AHMED | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMED | ||||||||
| AuthorizedOfficialMiddleName: | MUZAMMIL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2148930542 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084B0040X | A124696 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry |
No ID Information.