| Gamma Neuro Network Inc | |
|
475 Washington Blvd Marina Del Rey CA 90292-5287 | |
| (310) 923-1437 | |
| Not Available |
| Full Name | Gamma Neuro Network Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 475 Washington Blvd, Marina Del Rey, California |
| Authorized Official Name and Position | Daniel Vitantonio (PRESIDENT) |
| Authorized Official Contact | 3109231437 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gamma Neuro Network Inc Po Box 2277 Venice CA 90294-2277 Ph: (310) 923-1437 | Gamma Neuro Network Inc 475 Washington Blvd Marina Del Rey CA 90292-5287 Ph: (310) 923-1437 |
| NPI Number | 1992413157 |
|---|---|
| Provider Enumeration Date | 11/07/2022 |
| Last Update Date | 02/16/2024 |
| Certification Date | 02/16/2024 |
| Medicare PECOS PAC ID | 5294187290 |
|---|---|
| Medicare Enrollment ID | O20240116000542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992413157 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | (* (Not Available)) | Primary |
| Provider Name | Anna Koblik Chen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1972967982 PECOS PAC ID: 4789084195 Enrollment ID: I20221117003239 |
| Provider Name | Daniel Vitantonio |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1083024145 PECOS PAC ID: 5698002079 Enrollment ID: I20240116000621 |
| Provider Name | Christopher Bradley Lening |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1003182007 PECOS PAC ID: 1456628353 Enrollment ID: I20240119002613 |
| Provider Name | Sung-min Park |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1407293913 PECOS PAC ID: 0648548800 Enrollment ID: I20240124000126 |
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