Provider Demographics
NPI:1184270258
Name:EZUGHA PEDIATRIC NEUROLOGY AND ASSOCIATES PC
Entity type:Organization
Organization Name:EZUGHA PEDIATRIC NEUROLOGY AND ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:EZUGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-775-5035
Mailing Address - Street 1:2500 WIGWAM PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7113
Mailing Address - Country:US
Mailing Address - Phone:702-852-1155
Mailing Address - Fax:
Practice Address - Street 1:2500 WIGWAM PKWY STE 111
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7113
Practice Address - Country:US
Practice Address - Phone:702-852-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty