MEDICARE: BAASC

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	261QA1903X	Ambulatory Surgical Clinic/Center
2	163W00000X	Registered Nurse

General Provider Information

NPI Number	:	1588131395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAASC

Provider Business Mailing Address
First Line	:	4215 HAMILTON AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95130-1462
Country	:	US
Telephone Number	:	408-761-5847
Fax Number	:	408-761-5847

Provider Business Practice Location Address
First Line	:	4215 HAMILTON AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95130-1462
Country	:	US
Telephone Number	:	408-761-5847
Fax Number	:	408-761-5847

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. BARBARA LEE ROTH
Credential	:	RN
Telephone Number	:	408-761-5847

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	02/05/2021

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Directions to “BAASC ” Practice Location

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