Basic Information
| Provider Information | |||||||||
| NPI: | 1801871561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIMSTONE | ||||||||
| FirstName: | NEVILLE | ||||||||
| MiddleName: | ROY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1420 AMBASSADOR ST | ||||||||
| Address2: | APT 215 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900352826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102012008 | ||||||||
| FaxNumber: | 9167347908 | ||||||||
| Practice Location | |||||||||
| Address1: | 4150 V ST | ||||||||
| Address2: | DIVISION OF GASTROENTEROLOGY SUITE 3500 PSSB BLDG | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958171460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167343751 | ||||||||
| FaxNumber: | 9167347908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 09/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | A33420 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 00A334200 | 05 | CA | MEDICAID |