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1420 S Central Ave Glendale CA 91204-2508 | |
| (818) 502-1900 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 1420 S Central Ave, Glendale, California |
| Authorized Official Name and Position | Theophile Koury (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5103502600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1601 Cummins Dr Ste D Modesto CA 95358-6411 Ph: (510) 350-2600 | 1420 S Central Ave Glendale CA 91204-2508 Ph: (818) 502-1900 |
| NPI Number | 1871020032 |
|---|---|
| Provider Enumeration Date | 05/18/2017 |
| Last Update Date | 01/02/2020 |
| Certification Date | 01/02/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871020032 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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