Healthcare Provider Details

I. General information

NPI: 1104309210
Provider Name (Legal Business Name): BAY AREA CLINICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 EL CAMINO REAL
MENLO PARK CA
94025-4308
US

IV. Provider business mailing address

1175 SARATOGA AVE STE 14
SAN JOSE CA
95129-3427
US

V. Phone/Fax

Practice location:
  • Phone: 650-304-3906
  • Fax: 650-304-3907
Mailing address:
  • Phone: 408-996-7950
  • Fax: 408-996-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRANDI MUNIZ
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 408-996-7950