| Organization Name: | MARINA CENTER NEURODIAGNOSTICS INC |
| NPI Number: | 1891106712 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDWARDS MICHAEL (OWNER) |
| Mailing Address: | 3011 Grayson Ave Venice |
| State: | CA US |
| Postal Code: | 902914651 |
| Phone Number: | 5622013874 |
| Fax Number: | 8664418248 |
| NPI Enumeration Date: | 05/13/2014 |
| NPI Last Update Date: | 05/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | C3298806 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |