Healthcare Provider Details

I. General information

NPI: 1356429526
Provider Name (Legal Business Name): LPMI CASTRO VALLEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21030 REDWOOD RD
CASTRO VALLEY CA
94546-5920
US

IV. Provider business mailing address

21030 REDWOOD RD
CASTRO VALLEY CA
94546-5920
US

V. Phone/Fax

Practice location:
  • Phone: 510-537-4674
  • Fax: 877-282-6480
Mailing address:
  • Phone: 510-537-4674
  • Fax: 877-282-6480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RENEE - KAVON
Title or Position: V.P. MARKETING & PAYER CONTRACTING
Credential:
Phone: 530-367-5295