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General NPI Number Information
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NPI Number | 1255516589
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Entity Type | Organization
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Legal Business Name | LOS PALOS GASTROENTEROLOGY ANCILLARY SERVICES LLC
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Dates
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Enumeration Date | 01/05/2008
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 1081 LOS PALOS DR STE B
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City | SALINAS
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State | CA
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Zip | 93901-3916
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Country | US
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Telephone | 831-771-1456
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Fax | 831-783-3124
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Provider Business Mailing Address
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Address Line | 1081 LOS PALOS DR STE B
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City | SALINAS
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State | CA
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Zip | 93901-3916
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Country | US
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Telephone | 831-771-1456
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Fax | 831-783-3124
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MR. VIKAS K PATEL
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Credential | BILLING
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Telephone | 831-771-1456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | G54542
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 00G336240
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License Number State | CA
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