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General NPI Number Information
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NPI Number | 1134466899
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Entity Type | Organization
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Legal Business Name | PLEASANTON ALLERGY AND DERMATOLOGY INC
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Dates
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Enumeration Date | 01/14/2013
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 2324 SANTA RITA RD STE 2
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City | PLEASANTON
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State | CA
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Zip | 94566-4150
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Country | US
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Telephone | 925-846-5100
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Fax | 925-846-1982
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Provider Business Mailing Address
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Address Line | 2324 SANTA RITA RD STE 2
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City | PLEASANTON
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State | CA
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Zip | 94566-4150
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Country | US
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Telephone | 925-846-5100
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Fax | 925-846-1982
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. BETH LYNN COWAN
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Credential | M.D.
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Telephone | 925-846-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G8589
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G62905
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A85841
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A66278
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License Number State | CA
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