Provider Demographics
NPI:1457841520
Name:BAY AREA DIABETES PREVENTION PROGRAM
Entity Type:Organization
Organization Name:BAY AREA DIABETES PREVENTION PROGRAM
Other - Org Name:BEST LIFE COACHING CONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED LIFESTYLE COACH
Authorized Official - Prefix:
Authorized Official - First Name:BENITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-580-0090
Mailing Address - Street 1:2323 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2414
Mailing Address - Country:US
Mailing Address - Phone:415-580-0090
Mailing Address - Fax:
Practice Address - Street 1:2323 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2414
Practice Address - Country:US
Practice Address - Phone:415-580-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty