Provider Demographics
NPI:1235637398
Name:BAY AREA MOBILE CLINIC LLC
Entity Type:Organization
Organization Name:BAY AREA MOBILE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELIZAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-924-8911
Mailing Address - Street 1:15000 CITRUS COUNTRY DR # 414
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-6014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15000 CITRUS COUNTRY DR # 414
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-6014
Practice Address - Country:US
Practice Address - Phone:813-924-8911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center