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General NPI Number Information
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NPI Number | 1003289919
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Entity Type | Organization
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Legal Business Name | EAST BAY GYNECOLOGIC ONCOLOGY
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 105 MONTE VISTA RD
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City | ORINDA
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State | CA
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Zip | 94563-1619
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Country | US
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Telephone | 310-926-2451
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Fax |
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Provider Business Mailing Address
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Address Line | 105 MONTE VISTA RD
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City | ORINDA
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State | CA
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Zip | 94563-1619
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Country | US
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Telephone | 310-926-2451
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIMITRY LERNER
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Credential | MD
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Telephone | 310-926-2451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | A92223
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License Number State | CA
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