1912539891 NPI number — BAY AREA FOOT CARE, INC

Table of content: (NPI 1912539891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912539891 NPI number — BAY AREA FOOT CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY AREA FOOT CARE, INC
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:
BAY AREA FOOT CARE
Provider Other Organization Name Type Code:
3
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:
1912539891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20130 LAKE CHABOT RD STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASTRO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94546-5340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-581-1484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 N WIGET LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-309-5407
Provider Business Practice Location Address Fax Number:
925-891-4655
Provider Enumeration Date:
02/07/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CARPENTIERI
Authorized Official First Name:
JULIE-ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
510-399-0221

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6186880004 . This is a "DME" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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