Healthcare Provider Details

I. General information

NPI: 1851530646
Provider Name (Legal Business Name): LOS PALOS GASTROENTEROLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 LOS PALOS DR
SALINAS CA
93901-3916
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 831-771-1456
  • Fax: 831-757-4070
Mailing address:
  • Phone: 831-771-1456
  • Fax: 831-757-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOHN R CARLSON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 831-771-1456