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General NPI Number Information
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NPI Number | 1750589560
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Entity Type | Organization
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Legal Business Name | DONALD R. KNOTTS, M.D. INC
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20130 LAKE CHABOT RD SUITE 309
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5340
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Country | US
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Telephone | 510-886-3701
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Fax | 510-537-3194
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Provider Business Mailing Address
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Address Line | 20130 LAKE CHABOT RD SUITE 309
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5340
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Country | US
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Telephone | 510-886-3701
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Fax | 510-537-3194
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Authorized Official
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Title or Position | OWNER
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Name | DONALD R. KNOTTS
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Credential | M.D.
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Telephone | 510-886-3701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | G35548
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License Number State | CA
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