| Foothills Neurocare | |
|
1145 S Grand Ave Glendora CA 91740-5013 | |
| (909) 394-1667 | |
| (909) 575-4783 |
| Full Name | Foothills Neurocare |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 1145 S Grand Ave, Glendora, California |
| Authorized Official Name and Position | Stacey M Bayan (CEO) |
| Authorized Official Contact | 6262605468 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Foothills Neurocare 1145 S Grand Ave Glendora CA 91740-5013 Ph: (909) 394-1667 | Foothills Neurocare 1145 S Grand Ave Glendora CA 91740-5013 Ph: (909) 394-1667 |
| NPI Number | 1245821743 |
|---|---|
| Provider Enumeration Date | 01/28/2021 |
| Last Update Date | 05/06/2024 |
| Certification Date | 05/06/2024 |
| Medicare PECOS PAC ID | 4284049990 |
|---|---|
| Medicare Enrollment ID | O20210210001412 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245821743 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Stacey M. Bayan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164807954 PECOS PAC ID: 6507170214 Enrollment ID: I20150807014352 |
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