Healthcare Provider Details

I. General information

NPI: 1205917051
Provider Name (Legal Business Name): BAY WIDE DME COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 EUREKA SQ
PACIFICA CA
94044-2653
US

IV. Provider business mailing address

60 EUREKA SQ
PACIFICA CA
94044-2653
US

V. Phone/Fax

Practice location:
  • Phone: 650-355-0940
  • Fax: 650-355-0911
Mailing address:
  • Phone: 650-355-0940
  • Fax: 650-355-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number17536
License Number StateCA

VIII. Authorized Official

Name: TERESITA M. GALANG
Title or Position: PRESIDENT/CFO
Credential:
Phone: 650-355-0940