Provider Demographics
NPI:1134466899
Name:PLEASANTON ALLERGY AND DERMATOLOGY INC
Entity Type:Organization
Organization Name:PLEASANTON ALLERGY AND DERMATOLOGY INC
Other - Org Name:LIVERMORE ALLERGY MEDICAL CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-846-5100
Mailing Address - Street 1:2324 SANTA RITA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4150
Mailing Address - Country:US
Mailing Address - Phone:925-846-5100
Mailing Address - Fax:925-846-1982
Practice Address - Street 1:2324 SANTA RITA RD STE 2
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4150
Practice Address - Country:US
Practice Address - Phone:925-846-5100
Practice Address - Fax:925-846-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66278174400000X
CAG8589174400000X
CAG62905174400000X
CAA85841174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty