Healthcare Provider Details

I. General information

NPI: 1356374045
Provider Name (Legal Business Name): BAY AREA CONSORTIUM FOR QUALITY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 ELLSWORTH ST
BERKELEY CA
94705-1912
US

IV. Provider business mailing address

2908 ELLSWORTH ST
BERKELEY CA
94705-1912
US

V. Phone/Fax

Practice location:
  • Phone: 510-843-6194
  • Fax: 510-843-6297
Mailing address:
  • Phone: 510-843-6194
  • Fax: 510-843-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberC41403
License Number StateCA

VIII. Authorized Official

Name: DR. GWEN ROWE-LEE SYKES
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D
Phone: 510-652-3300