Healthcare Provider Details

I. General information

NPI: 1497144257
Provider Name (Legal Business Name): BAYCHILDREN'S MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 CHRISTIE AVE SUITE 300
EMERYVILLE CA
94608-1095
US

IV. Provider business mailing address

6475 CHRISTIE AVE SUITE 300
EMERYVILLE CA
94608-1095
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-7220
  • Fax:
Mailing address:
  • Phone: 415-476-7220
  • Fax: 415-353-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN APPENZELLER
Title or Position: EXECUTIVE DIRECTOR
Credential: RN, MSN
Phone: 415-476-7220