| Neurocenter Medical Clinic Inc | |
|
25485 Medical Center Dr #108 Murrieta CA 92562-6900 | |
| (951) 696-1818 | |
| (951) 696-2939 |
| Full Name | Neurocenter Medical Clinic Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 25485 Medical Center Dr, Murrieta, California |
| Authorized Official Name and Position | Raja B Boutros (OWNER) |
| Authorized Official Contact | 9516961818 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurocenter Medical Clinic Inc P.o Box 2770 Temecula CA 92593-2770 Ph: (951) 696-1818 | Neurocenter Medical Clinic Inc 25485 Medical Center Dr #108 Murrieta CA 92562-6900 Ph: (951) 696-1818 |
| NPI Number | 1770685968 |
|---|---|
| Provider Enumeration Date | 09/01/2006 |
| Last Update Date | 08/02/2022 |
| Certification Date | 08/02/2022 |
| Medicare PECOS PAC ID | 7315833472 |
|---|---|
| Medicare Enrollment ID | O20040225000638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770685968 | NPI | - | NPPES |
| 930048312 | Other | CA | RAILROAD MEDICARE # |
| ZZZ094462 | Other | CA | BLUE CROSS GROUP ID # |
| GR0091910 | Medicaid | CA | |
| 90050380 | Other | CA | PACIFICARE ID# |
| 0693834 | Other | CA | MEDICAL ID # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | F43949 (California) | Primary |
| Provider Name | Raja Boulos Boutros |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265535199 PECOS PAC ID: 9931095098 Enrollment ID: I20040225000751 |
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