MEDICARE: BAY AREA HYPERBARICS MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1093554024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA HYPERBARICS MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	14589 S BASCOM AVE
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-2026
Country	:	US
Telephone Number	:	408-800-0195
Fax Number	:

Provider Business Practice Location Address
First Line	:	14589 S BASCOM AVE
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-2026
Country	:	US
Telephone Number	:	408-800-0195
Fax Number	:	408-409-2015

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MS. LISA R ST JOHN
Credential	:
Telephone Number	:	408-800-0195

Provider Enumeration Date	:	05/20/2024
Last Update Date	:	06/18/2024

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