Provider Demographics
NPI:1225369507
Name:DIABLO VALLEY CRITICAL CARE PC
Entity Type:Organization
Organization Name:DIABLO VALLEY CRITICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-866-8822
Mailing Address - Street 1:PO BOX 3840
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-8840
Mailing Address - Country:US
Mailing Address - Phone:925-866-8822
Mailing Address - Fax:925-866-8323
Practice Address - Street 1:5401 NORRIS CANYON RD
Practice Address - Street 2:308
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5409
Practice Address - Country:US
Practice Address - Phone:925-866-8822
Practice Address - Fax:925-866-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94004207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty