MEDICARE: BAHIA MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1508390162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAHIA MEDICAL LLC

Provider Business Mailing Address
First Line	:	12622 MILOJOS RNCH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-3479
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12622 MILOJOS RNCH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-3479
Country	:	US
Telephone Number	:	914-563-7342
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	RICARDO FRANCISCO ROCA
Credential	:	LSA
Telephone Number	:	914-563-7342

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	04/20/2017

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