Provider Demographics
NPI:1851952113
Name:LOS BANOS PRIMARY CARE, INC
Entity Type:Organization
Organization Name:LOS BANOS PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAMINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-777-3500
Mailing Address - Street 1:PO BOX 579850
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-5850
Mailing Address - Country:US
Mailing Address - Phone:209-777-3500
Mailing Address - Fax:209-667-9900
Practice Address - Street 1:1120 W I ST STE B
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3970
Practice Address - Country:US
Practice Address - Phone:209-777-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty