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General NPI Number Information
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NPI Number | 1013424217
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Entity Type | Organization
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Legal Business Name | BAY AREA PEDIATRIC PRIMARY CARE INC.
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 244 N JACKSON AVE STE 203
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City | SAN JOSE
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State | CA
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Zip | 95116-1604
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Country | US
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Telephone | 408-729-0701
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Fax | 408-729-5085
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Provider Business Mailing Address
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Address Line | 244 N JACKSON AVE STE 203
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City | SAN JOSE
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State | CA
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Zip | 95116-1604
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Country | US
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Telephone | 408-729-0701
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Fax | 408-729-5085
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Authorized Official
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Title or Position | CEO
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Name | JERRY MERCADO
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Credential | MD
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Telephone | 408-729-0701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A105688
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License Number State | CA
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