Healthcare Provider Details

I. General information

NPI: 1255516589
Provider Name (Legal Business Name): LOS PALOS GASTROENTEROLOGY ANCILLARY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 LOS PALOS DR STE B
SALINAS CA
93901-3916
US

IV. Provider business mailing address

1081 LOS PALOS DR STE B
SALINAS CA
93901-3916
US

V. Phone/Fax

Practice location:
  • Phone: 831-771-1456
  • Fax: 831-783-3124
Mailing address:
  • Phone: 831-771-1456
  • Fax: 831-783-3124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number00G336240
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberG54542
License Number StateCA

VIII. Authorized Official

Name: MR. VIKAS K PATEL
Title or Position: ADMINISTRATIVE ASSISTANT
Credential: BILLING
Phone: 831-771-1456