Foothills Neurocare | |
1145 S Grand Ave Glendora CA 91740-5013 | |
(909) 394-1667 | |
(909) 575-4783 |
Full Name | Foothills Neurocare |
---|---|
Speciality | Clinical Neuropsychologist |
Location | 1145 S Grand Ave, Glendora, California |
Authorized Official Name and Position | Stacey M Bayan (CEO) |
Authorized Official Contact | 6262605468 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Foothills Neurocare 1145 S Grand Ave Glendora CA 91740-5013 Ph: (909) 394-1667 | Foothills Neurocare 1145 S Grand Ave Glendora CA 91740-5013 Ph: (909) 394-1667 |
NPI Number | 1245821743 |
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Provider Enumeration Date | 01/28/2021 |
Last Update Date | 05/06/2024 |
Certification Date | 05/06/2024 |
Medicare PECOS PAC ID | 4284049990 |
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Medicare Enrollment ID | O20210210001412 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245821743 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
Provider Name | Stacey M. Bayan |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1164807954 PECOS PAC ID: 6507170214 Enrollment ID: I20150807014352 |
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