Healthcare Provider Details

I. General information

NPI: 1508488784
Provider Name (Legal Business Name): BAY AREA COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 S WHITE RD STE 260
SAN JOSE CA
95148-2080
US

IV. Provider business mailing address

40910 FREMONT BLVD
FREMONT CA
94538-4375
US

V. Phone/Fax

Practice location:
  • Phone: 408-755-3905
  • Fax:
Mailing address:
  • Phone: 510-770-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JAGAT SHETH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 510-252-6810