Healthcare Provider Details

I. General information

NPI: 1760459416
Provider Name (Legal Business Name): BACAY-ARUIZA MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 NORMAN DR SUITE 103
MANTECA CA
95336-5900
US

IV. Provider business mailing address

1140 NORMAN DR SUITE 103
MANTECA CA
95336-5900
US

V. Phone/Fax

Practice location:
  • Phone: 209-825-6331
  • Fax: 209-825-6351
Mailing address:
  • Phone: 209-825-6331
  • Fax: 209-825-6351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA51759
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA76551
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberNP16223
License Number StateCA

VIII. Authorized Official

Name: DEANNA GOLDING
Title or Position: PRACTICE MANAGER
Credential:
Phone: 209-824-8419