Healthcare Provider Details

I. General information

NPI: 1649493180
Provider Name (Legal Business Name): BAY AREA COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
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: 510-770-8133
  • Fax: 510-713-6682
Mailing address:
  • Phone: 510-770-8040
  • Fax: 510-623-8926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number140000481
License Number StateCA

VIII. Authorized Official

Name: JAGHET SHETH
Title or Position: CEO
Credential:
Phone: 510-252-5808