Provider Demographics
NPI:1184823254
Name:AVENUES FOR HEALTH
Entity Type:Organization
Organization Name:AVENUES FOR HEALTH
Other - Org Name:AVENUES FOR HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-820-6456
Mailing Address - Street 1:901 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4034
Mailing Address - Country:US
Mailing Address - Phone:925-820-6456
Mailing Address - Fax:925-820-1134
Practice Address - Street 1:901 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4034
Practice Address - Country:US
Practice Address - Phone:925-820-6456
Practice Address - Fax:925-820-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG770720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty