PEDIATRIC NEUROLOGY THERAPEUTICS PC
Complete NPI Record 1801288535
Clinic/Center - Health Service in San Diego, CA
Active since March 04, 2015CLIA 05D2274367 · Waiver
Complete NPI Dataset
This page contains the complete raw NPPES record for Pediatric Neurology Therapeutics Pc (NPI 1801288535), a clinic/center organization in San Diego, CA. All 32 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1801288535 Field 1/32
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/32
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/32
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: CORTICA HEALTHCARE INC Field 4/32
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: PEDIATRIC NEUROLOGY THERAPEUTICS PC Field 5/32
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 3 Field 6/32
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 6160 CORNERSTONE CT E STE 100 Field 7/32
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: SAN DIEGO Field 8/32
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: CA Field 9/32
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 921213724 Field 10/32
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/32
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 8582168837 Field 12/32
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 8883830040 Field 13/32
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 6160 CORNERSTONE CT E STE 100 Field 14/32
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: SAN DIEGO Field 15/32
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: CA Field 16/32
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 921213724 Field 17/32
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/32
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 8587587842 Field 19/32
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 8589520502 Field 20/32
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: GOH Field 23/32
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: SUZANNE Field 24/32
- The first name of the authorized official.
- Authorized Official Title or Position: OWNER Field 25/32
- The title or position of the authorized official.
- Authorized Official Telephone Number: 8582168837 Field 26/32
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 261QH0100X Field 27/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 28/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 29/32
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Authorized Official Name Prefix Text: DR. Field 30/32
- The prefix used in the name of the authorized official associated with the provider's NPI record. Examples include Mr., Ms., Mrs., Dr., or other common professional or personal prefixes.
- Authorized Official Credential Text: M.D. Field 31/32
- The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
Secondary Practice Locations 8
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
2625 Townsgate Rd Ste 102
Location 1/8Westlake Village, CA 91361-5726 · Phone (805) 413-3009 · Fax (805) 413-4462
21515 Hawthorne Blvd Ste Gl-100
Location 2/8Torrance, CA 90503-6501 · Phone (424) 571-2618 · Fax (424) 571-2339
1320 Willow Pass Rd Ste 660
Location 3/8Concord, CA 94520-5232 · Phone (925) 494-9039 · Fax (925) 854-5897
4000 Civic Center Dr Ste 100
Location 4/8San Rafael, CA 94903-4151 · Phone (628) 877-0040 · Fax (628) 877-0047
611 N Brand Blvd Ste 100
Location 5/8Glendale, CA 91203-3240 · Phone (747) 286-2600 · Fax (747) 204-0181
5870 El Camino Real Ste 101
Location 6/8Carlsbad, CA 92008-8816 · Phone (760) 539-5818 · Fax (760) 539-5813
2500 Redhill Ave Ste 100
Location 7/8Santa Ana, CA 92705-5518 · Phone (949) 748-8571 · Fax (949) 748-8602
30131 Town Center Dr Ste 135
Location 8/8Laguna Niguel, CA 92677-2010 · Phone (949) 594-4455 · Fax (949) 748-8602
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