Provider Demographics
NPI:1447833405
Name:SOUTHERN CALIFORNIA NEURO MEDICAL SERVICES INC
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA NEURO MEDICAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIOMBETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-306-8876
Mailing Address - Street 1:4560 ADMIRALTY WAY STE 352
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5448
Mailing Address - Country:US
Mailing Address - Phone:310-306-8876
Mailing Address - Fax:310-822-3313
Practice Address - Street 1:4560 ADMIRALTY WAY STE 352
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5448
Practice Address - Country:US
Practice Address - Phone:310-306-8876
Practice Address - Fax:310-822-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury MedicineGroup - Single Specialty