| Southern California Movement Disorder Sepcialists | |
|
65 N Madison Ave Suite 410 Pasadena CA 91101-2035 | |
| (626) 792-6683 | |
| (626) 793-5475 |
| Full Name | Southern California Movement Disorder Sepcialists |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 65 N Madison Ave, Pasadena, California |
| Authorized Official Name and Position | Jerome P Lisk (PHYSICIAN) |
| Authorized Official Contact | 9403831770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern California Movement Disorder Sepcialists 3120 Medark Drive Denton TX 76208-6199 Ph: (940) 383-1770 | Southern California Movement Disorder Sepcialists 65 N Madison Ave Suite 410 Pasadena CA 91101-2035 Ph: (626) 792-6683 |
| NPI Number | 1598952616 |
|---|---|
| Provider Enumeration Date | 10/02/2007 |
| Last Update Date | 03/29/2021 |
| Certification Date | 03/05/2021 |
| Medicare PECOS PAC ID | 4789766379 |
|---|---|
| Medicare Enrollment ID | O20080205000362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598952616 | NPI | - | NPPES |
| DQ9581 | Other | CA | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | A88331 (California) | Primary |
| Provider Name | Jerome P Lisk |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1821036500 PECOS PAC ID: 4082667159 Enrollment ID: I20080205000358 |
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