Unknown Individual – Neurology Physician, NPI 1245204049

Unknown Individual is a healthcare provider. based in Anaheim, California. specializing in Neurology Physician. They hold a License No. G22684 (CA). The NPI Number for Unknown Individual is 1245204049

Main info

Organization
Inactive
55 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1245204049
Phone
(714) 635-2642
Address
1717 E LINCOLN AVE
Deactivation Date
13 October 2023

Doctor Profile

Medical School Name
UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
Secondary Phone
5629208394
Graduation Year
1971 (55 years ago)
PAC ID
9133156540
Group Practice PAC ID
0941299135
Professional Enrollment ID
I20090917000242
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • East Lincoln Avenue, Lincoln/Glessell, Anaheim, Orange County, California, 92806, United States

    ANAHEIM, CA 928054345

    Phone: (714) 635-2642

    Fax: (714) 635-8547

    Type: Location

  • Valley View Avenue, La Mirada, Los Angeles County, California, 90638, United States

    LA MIRADA, CA 906385824

    Phone: (714) 367-5360

    Fax: (714) 367-5428

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $19.

Total Amount is formed as General ($19) + Research ($0) + Ownership ($0) = $19.

Last reported payment date: 2023-01-12 • Largest payer in this snapshot: Nalu Medical, Inc. ($19).

Total Amount

$19

General + Research + Ownership

Payments

1

Total payment records

General Amount

$19

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-01-12

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Nalu Medical, Inc.$19
View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 92805)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0941299135View full group profile
NameSpecialtyState
N E U R O S U R G E R YCA
-CA
-CA
-CA
Orthopedic SurgeryIN
Orthopedic SurgeryCA
Physical Therapist In Private PracticeCA
Family PracticeNV
P O D I A T R YCA
-CA

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1245204049 when you need to reference Unknown Individual in forms, claims, or directories.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Neurology Physician. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Anaheim, California for Unknown Individual; download NPPES for the complete set.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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