Healthcare Provider Details

I. General information

NPI: 1992838437
Provider Name (Legal Business Name): BAY AREA CONSORTIUM FOR QUALITY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10850 MACARTHUR BLVD
OAKLAND CA
94605-5266
US

IV. Provider business mailing address

405 14TH ST SUITE 300
OAKLAND CA
94612-2715
US

V. Phone/Fax

Practice location:
  • Phone: 510-843-6194
  • Fax:
Mailing address:
  • Phone: 510-444-4300
  • Fax: 510-444-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number140000170
License Number StateCA

VIII. Authorized Official

Name: DR. GWEN ROWE-LEE SYKES
Title or Position: EXECUTIVE DIRECTOR
Credential: DRPH, MSW, MPH
Phone: 510-444-4300