Healthcare Provider Details

I. General information

NPI: 1295738805
Provider Name (Legal Business Name): BAY AREA REHABILITATION MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

2250 HAYES ST
SAN FRANCISCO CA
94117-1013
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-4411
  • Fax:
Mailing address:
  • Phone: 415-750-5761
  • Fax: 415-666-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG192980
License Number StateCA

VIII. Authorized Official

Name: HERBERT GOODMAN
Title or Position: PARTNER
Credential: M.D.
Phone: 510-204-4411