Provider Demographics
NPI:1396019022
Name:LOS ALTOS PSYCHIATRIC MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:LOS ALTOS PSYCHIATRIC MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:ANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-949-4433
Mailing Address - Street 1:288 QUINNHILL RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-4736
Mailing Address - Country:US
Mailing Address - Phone:650-949-4433
Mailing Address - Fax:650-949-3446
Practice Address - Street 1:288 QUINNHILL RD
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-4736
Practice Address - Country:US
Practice Address - Phone:650-949-4433
Practice Address - Fax:650-949-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC326172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C326170Medicare PIN