Healthcare Provider Details

I. General information

NPI: 1730760224
Provider Name (Legal Business Name): BAUMGARTL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 YGNACIO VALLEY RD STE 200
WALNUT CREEK CA
94598-3350
US

IV. Provider business mailing address

2161 YGNACIO VALLEY RD STE 200
WALNUT CREEK CA
94598-3350
US

V. Phone/Fax

Practice location:
  • Phone: 925-239-8904
  • Fax:
Mailing address:
  • Phone: 925-239-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MEREDITH
Title or Position: DIRECTOR
Credential:
Phone: 415-690-0307