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General NPI Number Information
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NPI Number | 1124260062
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Entity Type | Organization
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Legal Business Name | BAY VALLEY MEDICAL GROUP
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Dates
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Enumeration Date | 03/24/2009
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 27212 CALAROGA AVE
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City | HAYWARD
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State | CA
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Zip | 94545-4339
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Country | US
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Telephone | 510-785-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 27212 CALAROGA AVE
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City | HAYWARD
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State | CA
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Zip | 94545-4339
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Country | US
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Telephone | 510-785-5000
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Fax |
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Authorized Official
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Title or Position | MANAGER OF INFORMATION SYSTEMS
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Name | MATTHEW J BURDUSIS
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Credential |
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Telephone | 510-785-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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