MEDICARE: LIGHTYEAR HEALTH CLINIC IOWA, PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1811672397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTYEAR HEALTH CLINIC IOWA, PC

Provider Business Mailing Address
First Line	:	2950 BUSKIRK AVE STE 300
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-6900
Country	:	US
Telephone Number	:	888-380-0988
Fax Number	:	727-594-6296

Provider Business Practice Location Address
First Line	:	400 E COURT AVE STE 110
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50309-2027
Country	:	US
Telephone Number	:	888-380-0988
Fax Number	:	833-992-2313

Authorized Official
Title or Position	:	OWNER
Name	:	VINOD MITTA
Credential	:	MD
Telephone Number	:	888-380-0988

Provider Enumeration Date	:	06/21/2023
Last Update Date	:	06/21/2023

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