Healthcare Provider Details

I. General information

NPI: 1104357359
Provider Name (Legal Business Name): BAYCHILDREN'S PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLBY ST STE 301
BERKELEY CA
94705-2058
US

IV. Provider business mailing address

6475 CHRISTIE AVE SUITE 300
EMERYVILLE CA
94608-1095
US

V. Phone/Fax

Practice location:
  • Phone: 510-486-8344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JULIE HALLGREN
Title or Position: ASSOC DIRECTOR REVENUE CYCLE
Credential:
Phone: 415-476-4404