Provider Demographics
NPI:1598737926
Name:NEUROLOGY MEDICAL GROUP OF DIABLO VALLEY INC
Entity Type:Organization
Organization Name:NEUROLOGY MEDICAL GROUP OF DIABLO VALLEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-939-9400
Mailing Address - Street 1:400 TAYLOR BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523
Mailing Address - Country:US
Mailing Address - Phone:925-939-9400
Mailing Address - Fax:925-939-1819
Practice Address - Street 1:400 TAYLOR BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:925-939-9400
Practice Address - Fax:925-939-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ86688ZMedicare PIN