Healthcare Provider Details

I. General information

NPI: 1053879395
Provider Name (Legal Business Name): BAY AREA PAIN REHAB PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 LLEWELLYN AVE
CAMPBELL CA
95008-1948
US

IV. Provider business mailing address

4415 SAINT ANDREWS RD
OAKLAND CA
94605-4531
US

V. Phone/Fax

Practice location:
  • Phone: 408-364-1616
  • Fax:
Mailing address:
  • Phone: 415-246-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MIKIKO MURAKAMI
Title or Position: CEO
Credential: DO
Phone: 415-246-6080