Healthcare Provider Details

I. General information

NPI: 1932132297
Provider Name (Legal Business Name): NORTH BAY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 GLEN COVE MARINA RD #103
VALLEJO CA
94591
US

IV. Provider business mailing address

160 GLEN COVE MARINA RD #103
VALLEJO CA
94591
US

V. Phone/Fax

Practice location:
  • Phone: 707-648-0711
  • Fax: 707-648-1306
Mailing address:
  • Phone: 707-648-0711
  • Fax: 707-648-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY JADKOWSKI
Title or Position: PRACTICE MANAGER
Credential:
Phone: 707-648-0711