Provider Demographics
NPI:1578075982
Name:CALIFORNIA AVANT-GARDE PHYSICIANS
Entity Type:Organization
Organization Name:CALIFORNIA AVANT-GARDE PHYSICIANS
Other - Org Name:GOLDEN GATE FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANNERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:707-938-1977
Mailing Address - Street 1:686 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6805
Mailing Address - Country:US
Mailing Address - Phone:707-938-1977
Mailing Address - Fax:
Practice Address - Street 1:686 3RD ST W
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476
Practice Address - Country:US
Practice Address - Phone:707-938-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4684213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578075982OtherNPI