Healthcare Provider Details

I. General information

NPI: 1316243785
Provider Name (Legal Business Name): DIABLO VALLEY CHILD NEUROLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TAYLOR BLVD SUITE 306
PLEASANT HILL CA
94523-2147
US

IV. Provider business mailing address

400 TAYLOR BLVD SUITE 306
PLEASANT HILL CA
94523-2147
US

V. Phone/Fax

Practice location:
  • Phone: 925-691-9688
  • Fax: 925-691-9820
Mailing address:
  • Phone: 925-691-9688
  • Fax: 925-691-9820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA46000
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA46000
License Number StateCA

VIII. Authorized Official

Name: DR. CANDIDA BROWN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 925-691-9688