Healthcare Provider Details

I. General information

NPI: 1568922789
Provider Name (Legal Business Name): BAYCHILDREN'S PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 REDWOOD HWY FRONTAGE RD STE 216
MILL VALLEY CA
94941-3055
US

IV. Provider business mailing address

655 REDWOOD HWY FRONTAGE RD STE 216
MILL VALLEY CA
94941-3055
US

V. Phone/Fax

Practice location:
  • Phone: 415-383-3500
  • Fax: 415-383-3554
Mailing address:
  • Phone: 415-383-3500
  • Fax: 415-383-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH FARQUHAR
Title or Position: DIRECTOR, REVENUE CYCLE
Credential:
Phone: 415-476-6103