Healthcare Provider Details

I. General information

NPI: 1497760870
Provider Name (Legal Business Name): BAY VALLEY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20126 STANTON AVE STE 201
CASTRO VALLEY CA
94546-5271
US

IV. Provider business mailing address

27212 CALAROGA AVE
HAYWARD CA
94545-4339
US

V. Phone/Fax

Practice location:
  • Phone: 510-581-2559
  • Fax:
Mailing address:
  • Phone: 510-785-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW BURDUSIS
Title or Position: MANAGER OF INFORMATION SYSTEMS
Credential:
Phone: 510-266-5401