Healthcare Provider Details

I. General information

NPI: 1619494044
Provider Name (Legal Business Name): BAY AREA CLINICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 SARATOGA AVE STE 14
SAN JOSE CA
95129-3427
US

IV. Provider business mailing address

1175 SARATOGA AVE STE 14
SAN JOSE CA
95129-3427
US

V. Phone/Fax

Practice location:
  • Phone: 408-996-7950
  • Fax:
Mailing address:
  • Phone: 408-996-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDI MUNIZ
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 408-996-7950