MEDICARE: NORTHBAY HEALTHCARE GROUP

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	207RX0202X	Medical Oncology Physician
2	207RG0100X	Gastroenterology Physician
3	207RR0500X	Rheumatology Physician
4	282N00000X	General Acute Care Hospital	110000093	CA
5	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GR0093240	OTHER	CA	MEDI-CAL PHYSICIAN GROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	110000093	OTHER	CA	DHS LICENSE

General Provider Information

NPI Number	:	1760534713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHBAY HEALTHCARE GROUP

Provider Business Mailing Address
First Line	:	4500 BUSINESS CENTER DR
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-6888
Country	:	US
Telephone Number	:	707-646-3286
Fax Number	:	707-646-4886

Provider Business Practice Location Address
First Line	:	1020 NUT TREE RD # 390
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95687-4100
Country	:	US
Telephone Number	:	707-624-8000
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JOSEPH DANGINA
Credential	:
Telephone Number	:	707-646-3111

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	01/21/2026

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Directions to “NORTHBAY HEALTHCARE GROUP ” Practice Location

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