Provider Demographics
NPI:1073816765
Name:PETER BADUA PAC
Entity Type:Organization
Organization Name:PETER BADUA PAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAMON
Authorized Official - Last Name:FRACH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-984-2455
Mailing Address - Street 1:53 CRONIN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6719
Mailing Address - Country:US
Mailing Address - Phone:408-984-2455
Mailing Address - Fax:408-984-2456
Practice Address - Street 1:53 CRONIN DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-6719
Practice Address - Country:US
Practice Address - Phone:408-984-2455
Practice Address - Fax:408-984-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-18
Last Update Date:2010-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty