MEDICARE: MOUNT DIABLO MEDICAL, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician
2	207RP1001X	Pulmonary Disease Physician
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1114479961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT DIABLO MEDICAL, INC

Provider Business Mailing Address
First Line	:	5401 NORRIS CANYON ROAD
Second Line	:	SUITE 308
City	:	SAN RAMON
State	:	CA
Zip	:	94583-5408
Country	:	US
Telephone Number	:	925-866-8822
Fax Number	:	925-866-8323

Provider Business Practice Location Address
First Line	:	5401 NORRIS CANYON ROAD
Second Line	:	SUITE 308
City	:	SAN RAMON
State	:	CA
Zip	:	94583-5408
Country	:	US
Telephone Number	:	925-866-8822
Fax Number	:	925-866-8323

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. NARENDRA MALANI
Credential	:	MD
Telephone Number	:	925-866-8822

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	11/29/2016

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