=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982000717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLARIBEL BAISA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2014
-----------------------------------------------------
Last Update Date | 11/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2608 CENTRAL AVE STE 1
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94587-3148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-675-0600
-----------------------------------------------------
Fax | 510-675-0185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15921 VIA CONEJO
-----------------------------------------------------
City | SAN LORENZO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94580-2338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-590-0434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------