Organization
ST. MICHAEL'S NEUROLOGY MEDICAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHERIF A DIMYAN D.O. (PRESIDENT)
(310) 225-5599
Entity
Organization
Contact information
Practice address
1141 W REDONDO BEACH BLVD, SUITE 207, GARDENA, CA 90247-3586
(310) 225-5599
(310) 225-5660
Mailing address
1141 W REDONDO BEACH BLVD, SUITE 207, GARDENA, CA 90247-3586
(310) 225-5599
(310) 225-5660
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
20A6410
CA
2084N0400X
Neurology Physician
Primary
20A6140
CA
2084N0600X
Clinical Neurophysiology Physician
20A6410
CA
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
20A6410
CA
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
20A6410
CA
2084V0102X
Vascular Neurology Physician
20A6410
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX6461
—
CA
01
—
20A6410
MEDICAL LICENSE
CA
Enumeration date
03/15/2007
Last updated
03/10/2009
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