1902516503 NPI number — BAY AREA FOOT CARE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902516503 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:
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:
1902516503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2023
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:
510-581-7779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2925 SPAFFORD ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95618-6808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-459-4398
Provider Business Practice Location Address Fax Number:
916-965-6715
Provider Enumeration Date:
12/05/2022

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: 6186880025 . This is a "DME" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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