Provider Demographics
NPI:1255516589
Name:LOS PALOS GASTROENTEROLOGY ANCILLARY SERVICES LLC
Entity type:Organization
Organization Name:LOS PALOS GASTROENTEROLOGY ANCILLARY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:VIKAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:BILLING
Authorized Official - Phone:831-771-1456
Mailing Address - Street 1:1081 LOS PALOS DR STE B
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3916
Mailing Address - Country:US
Mailing Address - Phone:831-771-1456
Mailing Address - Fax:831-783-3124
Practice Address - Street 1:1081 LOS PALOS DR STE B
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3916
Practice Address - Country:US
Practice Address - Phone:831-771-1456
Practice Address - Fax:831-783-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-05
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54542207ZP0105X
CA00G336240207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty