Healthcare Provider Details

I. General information

NPI: 1477889962
Provider Name (Legal Business Name): SANJIV M BAXI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE ROOM 987
SAN FRANCISCO CA
94143-0119
US

IV. Provider business mailing address

1450 TREAT BLVD # 300
WALNUT CREEK CA
94597-2168
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1528
  • Fax: 415-502-1976
Mailing address:
  • Phone: 925-952-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA114670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: