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General NPI Number Information
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NPI Number | 1164592119
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Entity Type | Organization
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Legal Business Name | BAY AREA DIGESTIVE HEALTH MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 1850 SULLIVAN AVE SUITE 520
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City | DALY CITY
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State | CA
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Zip | 94015-2221
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Country | US
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Telephone | 650-756-5000
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Fax | 650-756-5903
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Provider Business Mailing Address
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Address Line | 1850 SULLIVAN AVE SUITE 520
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City | DALY CITY
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State | CA
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Zip | 94015-2221
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Country | US
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Telephone | 650-756-5000
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Fax | 650-756-5903
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Authorized Official
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Title or Position | MEDICAL BILLER
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Name | LIZA YASUMATSU
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Credential |
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Telephone | 650-756-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | CA
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