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General NPI Number Information
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NPI Number | 1669553970
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Entity Type | Organization
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Legal Business Name | RAVI PANJABI INC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 3160 CASTRO VALLEY BLVD STE A
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5565
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Country | US
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Telephone | 510-582-8555
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Fax | 510-581-8686
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Provider Business Mailing Address
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Address Line | 19850 LAKE CHABOT RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-4002
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Country | US
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Telephone | 510-582-8555
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Fax | 510-581-8686
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAVI S PANJABI
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Credential | MD
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Telephone | 510-582-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NPF10862
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA16390
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License Number State | CA
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