Healthcare Provider Details

I. General information

NPI: 1669293775
Provider Name (Legal Business Name): BAY AREA ENDOCRINOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 REDWOOD HWY FRONTAGE RD STE 102
MILL VALLEY CA
94941-3046
US

IV. Provider business mailing address

183 MORAGA WAY
ORINDA CA
94563-3442
US

V. Phone/Fax

Practice location:
  • Phone: 415-569-4470
  • Fax:
Mailing address:
  • Phone: 415-336-4930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: AMER BUDAYR
Title or Position: CEO
Credential: MD
Phone: 925-386-6001