MEDICARE: LOS ALTOS PSYCHIATRIC MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	C32617	CA

General Provider Information

NPI Number	:	1396019022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ALTOS PSYCHIATRIC MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	288 QUINNHILL RD
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-4736
Country	:	US
Telephone Number	:	650-949-4433
Fax Number	:	650-949-3446

Provider Business Practice Location Address
First Line	:	288 QUINNHILL RD
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-4736
Country	:	US
Telephone Number	:	650-949-4433
Fax Number	:	650-949-3446

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRANK LLOYD ANNIS
Credential	:	M.D.
Telephone Number	:	650-949-4433

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	06/14/2017

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