Healthcare Provider Details

I. General information

NPI: 1174571871
Provider Name (Legal Business Name): BODYPLAN INSTITUTE OF WALNUT CREEK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 S MAIN ST #202
WALNUT CREEK CA
94596-5116
US

IV. Provider business mailing address

1255 S MAIN ST #202
WALNUT CREEK CA
94596-5116
US

V. Phone/Fax

Practice location:
  • Phone: 925-627-2777
  • Fax: 925-627-2788
Mailing address:
  • Phone: 925-627-2777
  • Fax: 925-627-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RENEE (NONE) KAVON
Title or Position: V.P. MARKETING & CONTRACTING
Credential:
Phone: 530-367-5295