Provider Demographics
NPI:1366680282
Name:RAY BAYATI MD PC
Entity Type:Organization
Organization Name:RAY BAYATI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-626-4838
Mailing Address - Street 1:5120 WARD LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2842
Mailing Address - Country:US
Mailing Address - Phone:916-500-2474
Mailing Address - Fax:916-626-4837
Practice Address - Street 1:1 MEDICAL PLAZA DR
Practice Address - Street 2:WOUND CARE CLINIC
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3037
Practice Address - Country:US
Practice Address - Phone:916-781-1386
Practice Address - Fax:916-781-1456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABT143AMedicare PIN