| Prime Neurology, Inc. | |
|
16350 Ventura Blvd Ste D323 Encino CA 91436 | |
| (888) 618-5288 | |
| (888) 618-5288 |
| Full Name | Prime Neurology, Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 16350 Ventura Blvd Ste D323, Encino, California |
| Authorized Official Name and Position | Kimberly Idoko (CEO) |
| Authorized Official Contact | 8886185288 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Neurology, Inc. 16350 Ventura Blvd Ste D323 Encino CA 91436-5300 Ph: (888) 618-5288 | Prime Neurology, Inc. 16350 Ventura Blvd Ste D323 Encino CA 91436 Ph: (888) 618-5288 |
| NPI Number | 1770906836 |
|---|---|
| Provider Enumeration Date | 01/27/2014 |
| Last Update Date | 07/01/2019 |
| Medicare PECOS PAC ID | 9133342710 |
|---|---|
| Medicare Enrollment ID | O20140529000979 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770906836 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Kimberly Idoko |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1003080896 PECOS PAC ID: 2769605344 Enrollment ID: I20140605000309 |
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