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General NPI Number Information
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NPI Number | 1225109358
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Entity Type | Organization
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Legal Business Name | LAURENCE ATHOS M D INC
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Dates
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Enumeration Date | 11/12/2006
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 19830 LAKE CHABOT RD SUITE D
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-4063
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Country | US
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Telephone | 510-889-1677
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Fax | 510-889-5823
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Provider Business Mailing Address
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Address Line | 19830 LAKE CHABOT RD SUITE D
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-4063
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Country | US
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Telephone | 510-889-1677
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Fax | 510-889-5823
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURENCE ATHOS
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Credential | M.D.
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Telephone | 510-889-1677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | G34546
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License Number State | CA
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