Provider Demographics
NPI:1558477273
Name:BAY AREA EAR, NOSE, AND THROAT MEDICAL GROUP
Entity Type:Organization
Organization Name:BAY AREA EAR, NOSE, AND THROAT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M. D. /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUBENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:510-352-5470
Mailing Address - Street 1:13847 E 14TH ST
Mailing Address - Street 2:#200
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2632
Mailing Address - Country:US
Mailing Address - Phone:510-352-5470
Mailing Address - Fax:
Practice Address - Street 1:13847 E 14TH ST
Practice Address - Street 2:#200
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2632
Practice Address - Country:US
Practice Address - Phone:510-352-5470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33407207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G334070Medicaid
CA00G334070Medicaid
CAZZZ18581ZMedicare PIN
CAF95843Medicare UPIN