Provider Demographics
NPI:1679176820
Name:PRONEUROSURGERY
Entity type:Organization
Organization Name:PRONEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AZADEH
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-927-4391
Mailing Address - Street 1:7 QUAIL RIDGE RD S
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90274-5017
Mailing Address - Country:US
Mailing Address - Phone:310-927-4391
Mailing Address - Fax:
Practice Address - Street 1:ST MARY MEDICAL CENTER
Practice Address - Street 2:1050 LINDEN AVENUE, 2ND FLOOR NEUROSCIENCE CLINIC
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813
Practice Address - Country:US
Practice Address - Phone:562-491-9270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty