Healthcare Provider Details

I. General information

NPI: 1518780840
Provider Name (Legal Business Name): BAY WELL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ADELINE ST
OAKLAND CA
94607-2608
US

IV. Provider business mailing address

700 ADELINE ST
OAKLAND CA
94607-2608
US

V. Phone/Fax

Practice location:
  • Phone: 713-449-3536
  • Fax:
Mailing address:
  • Phone: 713-449-3536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KANWAL QIDWAI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 713-449-3536