Provider Demographics
NPI:1356429526
Name:LPMI CASTRO VALLEY, LLC
Entity type:Organization
Organization Name:LPMI CASTRO VALLEY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V.P. MARKETING & PAYER CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:-
Authorized Official - Last Name:KAVON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-367-5295
Mailing Address - Street 1:21030 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5920
Mailing Address - Country:US
Mailing Address - Phone:510-537-4674
Mailing Address - Fax:877-282-6480
Practice Address - Street 1:21030 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5920
Practice Address - Country:US
Practice Address - Phone:510-537-4674
Practice Address - Fax:877-282-6480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX IDENTIFICATION NUMBER