Healthcare Provider Details

I. General information

NPI: 1205225505
Provider Name (Legal Business Name): MONTEREY BAY OBSERVATION MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23625 HOLMAN HWY
MONTEREY CA
93940-5902
US

IV. Provider business mailing address

PO BOX 3009
SAN DIMAS CA
91773-7009
US

V. Phone/Fax

Practice location:
  • Phone: 831-625-4900
  • Fax: 831-625-4763
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMEER R. BAKHDA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-447-0296