Provider Demographics
NPI:1871735654
Name:AMBULATORY NEUROLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:AMBULATORY NEUROLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIBARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-447-5904
Mailing Address - Street 1:PO BOX 28669
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92198-0669
Mailing Address - Country:US
Mailing Address - Phone:888-447-5904
Mailing Address - Fax:866-273-5772
Practice Address - Street 1:1333 COLLEGE AVE
Practice Address - Street 2:SUITE L
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-1150
Practice Address - Country:US
Practice Address - Phone:262-554-7255
Practice Address - Fax:866-273-5772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty