| Southland Neurologic Institute A Medical Corporation | |
|
3747 Worsham Avenue #100 Long Beach CA 90808-1774 | |
| (562) 430-4513 | |
| (562) 430-7718 |
| Full Name | Southland Neurologic Institute A Medical Corporation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3747 Worsham Avenue, Long Beach, California |
| Authorized Official Name and Position | Alan H Cohen (CEO) |
| Authorized Official Contact | 5624304513 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southland Neurologic Institute A Medical Corporation 3747 Worsham Avenue #100 Long Beach CA 90808-1774 Ph: (562) 430-4513 | Southland Neurologic Institute A Medical Corporation 3747 Worsham Avenue #100 Long Beach CA 90808-1774 Ph: (562) 430-4513 |
| NPI Number | 1528498409 |
|---|---|
| Provider Enumeration Date | 11/14/2013 |
| Last Update Date | 11/03/2015 |
| Medicare PECOS PAC ID | 0446555023 |
|---|---|
| Medicare Enrollment ID | O20160218001757 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528498409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | G20309 (California) | Primary |
| Provider Name | Omid Omidvar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1184678583 PECOS PAC ID: 4587691654 Enrollment ID: I20050720000486 |
| Provider Name | Nirav S Patel |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881631539 PECOS PAC ID: 1557378783 Enrollment ID: I20060314000289 |
| Provider Name | Nima Ramezan Arab |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1699705772 PECOS PAC ID: 4284635103 Enrollment ID: I20070119000375 |
| Provider Name | Alan H Cohen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1902843659 PECOS PAC ID: 0941209811 Enrollment ID: I20090204000534 |
| Provider Name | Michael L Thompson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1689820433 PECOS PAC ID: 9931241882 Enrollment ID: I20100115000272 |
| Provider Name | Liza N Ros |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972836484 PECOS PAC ID: 5496911315 Enrollment ID: I20120723000106 |
| Provider Name | George C Wang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1124344767 PECOS PAC ID: 6507180924 Enrollment ID: I20150113001419 |
| Provider Name | Melissa Dodson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306204698 PECOS PAC ID: 8921386277 Enrollment ID: I20161020002396 |
| Provider Name | Galina Nikolskaya |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1457620965 PECOS PAC ID: 2567748015 Enrollment ID: I20170417001952 |
| Provider Name | Neil Maluste |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1013358241 PECOS PAC ID: 2668702861 Enrollment ID: I20191002000862 |
| Provider Name | Mahsa Matloobi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1609101211 PECOS PAC ID: 7719111350 Enrollment ID: I20200609002130 |
| Provider Name | Eun Hyeo Ha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215547484 PECOS PAC ID: 4981099777 Enrollment ID: I20220314001083 |
| Provider Name | Rebecca Rodgers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932875291 PECOS PAC ID: 7719369537 Enrollment ID: I20220726003101 |
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