Healthcare Provider Details

I. General information

NPI: 1801933668
Provider Name (Legal Business Name): CASTRO VALLEY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22290 FOOTHILL BLVD., STE. 1
HAYWARD CA
94541
US

IV. Provider business mailing address

22290 FOOTHILL BLVD., STE. 1
HAYWARD CA
94541
US

V. Phone/Fax

Practice location:
  • Phone: 510-581-1446
  • Fax: 510-581-1805
Mailing address:
  • Phone: 510-581-1446
  • Fax: 510-581-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CAREN VANCE
Title or Position: PARTNER PHYSICIAN
Credential: MD
Phone: 510-581-1446