1851892459 NPI number — BAYCHILDREN'S PHYSICIANS

Table of content: (NPI 1851892459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851892459 NPI number — BAYCHILDREN'S PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYCHILDREN'S PHYSICIANS
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:
UBCP MFM PDC WALNUT CREEK
Provider Other Organization Name Type Code:
5
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:
1851892459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6475 CHRISTIE AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMERYVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94608-2263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-476-4407
Provider Business Mailing Address Fax Number:
415-353-2198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2970 CAMINO DIABLO STE 210
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:
94597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-979-9350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HALLGREN
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSOC DIRECTOR REVENUE CYCLE
Authorized Official Telephone Number:
415-476-4404

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1922124866 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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