Provider Demographics
NPI:1598013930
Name:REVEAL DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:REVEAL DIAGNOSTICS, LLC
Other - Org Name:REVEAL DIAGNOSTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-837-5990
Mailing Address - Street 1:4217 PIEDMONT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611
Mailing Address - Country:US
Mailing Address - Phone:415-837-5990
Mailing Address - Fax:888-808-6160
Practice Address - Street 1:490 POST ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1401
Practice Address - Country:US
Practice Address - Phone:415-837-5990
Practice Address - Fax:415-358-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty