Healthcare Provider Details

I. General information

NPI: 1881806313
Provider Name (Legal Business Name): CAROL ANN BANYAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SYCAMORE VALLEY RD W
DANVILLE CA
94526-3947
US

IV. Provider business mailing address

203 SYCAMORE VALLEY RD W
DANVILLE CA
94526-3947
US

V. Phone/Fax

Practice location:
  • Phone: 925-838-2138
  • Fax: 925-838-2136
Mailing address:
  • Phone: 925-838-2138
  • Fax: 925-838-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberA052936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: