Provider Demographics
NPI:1750317269
Name:WALNUT CREEK HEARTSCAN, LLC
Entity Type:Organization
Organization Name:WALNUT CREEK HEARTSCAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:WOOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-591-0350
Mailing Address - Street 1:2161 YGNACIO VALLEY RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3396
Mailing Address - Country:US
Mailing Address - Phone:925-939-3003
Mailing Address - Fax:925-939-3036
Practice Address - Street 1:2161 YGNACIO VALLEY RD
Practice Address - Street 2:STE 100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3396
Practice Address - Country:US
Practice Address - Phone:925-939-3003
Practice Address - Fax:925-939-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory