Healthcare Provider Details

I. General information

NPI: 1518588490
Provider Name (Legal Business Name): CLAUDIA S VANOVER RT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

975 SERENO DR
VALLEJO CA
94589-2441
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-4657
  • Fax:
Mailing address:
  • Phone: 707-651-4657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberRHP00085425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: