1710212691 NPI number — BAY AREA FAMILY PRACTICE PA

Table of content: (NPI 1710212691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710212691 NPI number — BAY AREA FAMILY PRACTICE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY AREA FAMILY PRACTICE PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710212691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7758 WALLACE RD STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32819-7218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-271-8933
Provider Business Mailing Address Fax Number:
407-271-8934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7758 WALLACE RD STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32819-7218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-271-8933
Provider Business Practice Location Address Fax Number:
407-271-8934
Provider Enumeration Date:
10/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MUQEEM
Authorized Official First Name:
MOHAMMED
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
407-846-2786

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME99720 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 011529800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com