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General NPI Number Information
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NPI Number | 1609395961
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Entity Type | Organization
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Legal Business Name | BAY WELLNESS
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 03/26/2019
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Provider Practice Location Address
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Address Line | 5715 MARKET ST STE #D
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City | OAKLAND
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State | CA
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Zip | 94608
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Country | US
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Telephone | 510-469-4741
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Fax | 510-654-4209
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Provider Business Mailing Address
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Address Line | 5715 MARKET ST STE D
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City | OAKLAND
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State | CA
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Zip | 94608-2811
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Country | US
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Telephone | 510-469-4741
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Fax | 510-654-4206
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEODROS SHAWL
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Credential | DC
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Telephone | 510-469-4741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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