| Southern California Head Pain And Neurologic Institute Inc | |
|
3555 Loma Vista Rd #115 Ventura CA 93003-3161 | |
| (805) 648-3158 | |
| (805) 648-2997 |
| Full Name | Southern California Head Pain And Neurologic Institute Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3555 Loma Vista Rd, Ventura, California |
| Authorized Official Name and Position | Scot J Richardson (OWNER) |
| Authorized Official Contact | 8056483158 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern California Head Pain And Neurologic Institute Inc 3555 Loma Vista Rd Ste 115 Ventura CA 93003-3161 Ph: (805) 648-3158 | Southern California Head Pain And Neurologic Institute Inc 3555 Loma Vista Rd #115 Ventura CA 93003-3161 Ph: (805) 648-3158 |
| NPI Number | 1003847435 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 07/17/2015 |
| Medicare PECOS PAC ID | 7911932686 |
|---|---|
| Medicare Enrollment ID | O20050930000491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003847435 | NPI | - | NPPES |
| A60878 | Other | CA | LICENSE |
| W19218 | Other | CA | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | A60878 (California) | Primary |
| Provider Name | Scot J Richardson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1437141058 PECOS PAC ID: 9234198862 Enrollment ID: I20041007000741 |
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