Healthcare Provider Details

I. General information

NPI: 1114479961
Provider Name (Legal Business Name): MOUNT DIABLO MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 NORRIS CANYON ROAD SUITE 308
SAN RAMON CA
94583-5408
US

IV. Provider business mailing address

5401 NORRIS CANYON ROAD SUITE 308
SAN RAMON CA
94583-5408
US

V. Phone/Fax

Practice location:
  • Phone: 925-866-8822
  • Fax: 925-866-8323
Mailing address:
  • Phone: 925-866-8822
  • Fax: 925-866-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NARENDRA MALANI
Title or Position: DIRECTOR
Credential: MD
Phone: 925-866-8822