Healthcare Provider Details

I. General information

NPI: 1831291350
Provider Name (Legal Business Name): EAST BAY PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 SANTA RITA RD SUITE 12
PLEASANTON CA
94566-4152
US

IV. Provider business mailing address

2324 SANTA RITA RD SUITE 12
PLEASANTON CA
94566-4152
US

V. Phone/Fax

Practice location:
  • Phone: 925-462-7700
  • Fax: 925-462-7700
Mailing address:
  • Phone: 925-462-7700
  • Fax: 925-462-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA77244
License Number StateCA

VIII. Authorized Official

Name: DR. ELMER JUMIG
Title or Position: PRESIDENT
Credential: MD
Phone: 925-462-7700