| California Neurointerventional Surgeons, Inc | |
|
4445 Magnolia Ave Riverside CA 92501-4135 | |
| (951) 788-3000 | |
| Not Available |
| Full Name | California Neurointerventional Surgeons, Inc |
|---|---|
| Speciality | Radiology |
| Location | 4445 Magnolia Ave, Riverside, California |
| Authorized Official Name and Position | Charles Stout (PRESIDENT AND CEO) |
| Authorized Official Contact | 9095540400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| California Neurointerventional Surgeons, Inc 700 E Redlands Blvd Ste U714 Redlands CA 92373-6109 Ph: (909) 554-0400 | California Neurointerventional Surgeons, Inc 4445 Magnolia Ave Riverside CA 92501-4135 Ph: (951) 788-3000 |
| NPI Number | 1417315300 |
|---|---|
| Provider Enumeration Date | 02/05/2016 |
| Last Update Date | 07/06/2021 |
| Certification Date | 07/06/2021 |
| Medicare PECOS PAC ID | 2668717125 |
|---|---|
| Medicare Enrollment ID | O20190103000009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417315300 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 2085R0204X | Radiology - Vascular & Interventional Radiology | (* (Not Available)) | Primary |
| Provider Name | Lisa Sovory |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306843677 PECOS PAC ID: 8921065012 Enrollment ID: I20081031000364 |
| Provider Name | George P Teitelbaum |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982645602 PECOS PAC ID: 3779623236 Enrollment ID: I20091215000315 |
| Provider Name | Charles E Stout |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1679770994 PECOS PAC ID: 6002094216 Enrollment ID: I20110616000605 |
| Provider Name | Tejon Woods |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285911214 PECOS PAC ID: 3476716507 Enrollment ID: I20120529000477 |
| Provider Name | Jacqueline Imbert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215246079 PECOS PAC ID: 7113180167 Enrollment ID: I20120531000458 |
| Provider Name | Rony Dekermenjian |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1972766657 PECOS PAC ID: 1254564792 Enrollment ID: I20140507001123 |
| Provider Name | Rajan C Chopra |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1568605350 PECOS PAC ID: 7214177146 Enrollment ID: I20160308000501 |
| Provider Name | Lorena H Ruiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306205208 PECOS PAC ID: 5496054835 Enrollment ID: I20160509001620 |
| Provider Name | Dhrupad Joshi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1891103735 PECOS PAC ID: 7911299367 Enrollment ID: I20160706001008 |
| Provider Name | Juan Lozano |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871750604 PECOS PAC ID: 4284873266 Enrollment ID: I20161208001758 |
| Provider Name | Shawn Robert Hurley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013465202 PECOS PAC ID: 3173892437 Enrollment ID: I20170630001137 |
| Provider Name | Shoko O Nitta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780917021 PECOS PAC ID: 5799022927 Enrollment ID: I20190125003024 |
| Provider Name | Mark Medhat Girgis |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1679921316 PECOS PAC ID: 2163715590 Enrollment ID: I20200805001035 |
| Provider Name | Travis Martin Petrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255982492 PECOS PAC ID: 1355754151 Enrollment ID: I20210118000647 |
| Provider Name | Benjamin John Caudill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871140772 PECOS PAC ID: 2466858626 Enrollment ID: I20210914000693 |
| Provider Name | Tonya J Waters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902402506 PECOS PAC ID: 1355749532 Enrollment ID: I20211004001045 |
| Provider Name | Amber Brittany Mejia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770240988 PECOS PAC ID: 0042602500 Enrollment ID: I20220113002284 |
| Provider Name | Rhea M Mulvina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407505464 PECOS PAC ID: 1254715659 Enrollment ID: I20220902002410 |
| Provider Name | Vanessa Jacqueline St Clair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528775392 PECOS PAC ID: 4789041013 Enrollment ID: I20230601001379 |
| Provider Name | Hailey Marie Chace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760177612 PECOS PAC ID: 3375997067 Enrollment ID: I20230928003820 |
| Provider Name | Anaia Cimone Whitehead |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295518355 PECOS PAC ID: 4789033267 Enrollment ID: I20231208002157 |
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