Provider Demographics
NPI:1902140387
Name:REAL TIME NEUROMONITORING SERVICES
Entity Type:Organization
Organization Name:REAL TIME NEUROMONITORING SERVICES
Other - Org Name:REAL TIME NEUROMONTORING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-600-1572
Mailing Address - Street 1:PO BOX 2864
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92814-0864
Mailing Address - Country:US
Mailing Address - Phone:818-600-1572
Mailing Address - Fax:877-625-7254
Practice Address - Street 1:7853 ESTANCIA WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5579
Practice Address - Country:US
Practice Address - Phone:818-600-1572
Practice Address - Fax:877-625-7254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME942182084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30990ZOtherMEDICARE ID-TYPE UNSPECIFIED. FL
FL30990ZOtherMEDICARE ID-TYPE UNSPECIFIED. FL