Healthcare Provider Details

I. General information

NPI: 1669553970
Provider Name (Legal Business Name): RAVI PANJABI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 CASTRO VALLEY BLVD STE A
CASTRO VALLEY CA
94546-5565
US

IV. Provider business mailing address

19850 LAKE CHABOT RD
CASTRO VALLEY CA
94546-4002
US

V. Phone/Fax

Practice location:
  • Phone: 510-582-8555
  • Fax: 510-581-8686
Mailing address:
  • Phone: 510-582-8555
  • Fax: 510-581-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA16390
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPF10862
License Number StateCA

VIII. Authorized Official

Name: DR. RAVI S PANJABI
Title or Position: OWNER
Credential: MD
Phone: 510-582-8555