Healthcare Provider Details

I. General information

NPI: 1033296272
Provider Name (Legal Business Name): BAY AREA COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/01/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 MOWRY AVE STE 3B
FREMONT CA
94538-1621
US

IV. Provider business mailing address

40910 FREMONT BLVD
FREMONT CA
94538-4375
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-8040
  • Fax: 510-623-8926
Mailing address:
  • Phone: 510-770-8040
  • Fax: 510-623-8926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. ZETTIE D PAGE III
Title or Position: CEO
Credential: MD, PH.D, MBA, MSW,
Phone: 510-252-6811