Healthcare Provider Details

I. General information

NPI: 1558968727
Provider Name (Legal Business Name): LIGHTYEAR HEALTH CLINIC CALIFORNIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 BUSKIRK AVE STE 300
WALNUT CREEK CA
94597-6900
US

IV. Provider business mailing address

2950 BUSKIRK AVE STE 300
WALNUT CREEK CA
94597-6900
US

V. Phone/Fax

Practice location:
  • Phone: 888-380-0988
  • Fax: 289-236-3022
Mailing address:
  • Phone: 888-380-0988
  • Fax: 289-236-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VAIBHAV RIKHYE
Title or Position: VICE PRESIDENT OPERATIONS
Credential:
Phone: 888-380-0988