Healthcare Provider Details

I. General information

NPI: 1750357539
Provider Name (Legal Business Name): BAYSPRING MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 BUSH STREET SUITE # 500
SAN FRANCISCO CA
94109-5976
US

IV. Provider business mailing address

1199 BUSH STREET SUITE # 500
SAN FRANCISCO CA
94109-5976
US

V. Phone/Fax

Practice location:
  • Phone: 415-267-2600
  • Fax: 415-674-2601
Mailing address:
  • Phone: 415-267-2600
  • Fax: 415-674-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA46339
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG57068
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP 11738
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA52654
License Number StateCA

VIII. Authorized Official

Name: MS. YVONNE HAWKINS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 415-674-2627