Provider Demographics
NPI:1609395961
Name:BAY WELLNESS
Entity Type:Organization
Organization Name:BAY WELLNESS
Other - Org Name:BAY ORTHOPEDIC SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODROS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAWL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-469-4741
Mailing Address - Street 1:5715 MARKET ST STE D
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2811
Mailing Address - Country:US
Mailing Address - Phone:510-469-4741
Mailing Address - Fax:510-654-4206
Practice Address - Street 1:5715 MARKET ST STE #D
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608
Practice Address - Country:US
Practice Address - Phone:510-469-4741
Practice Address - Fax:510-654-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies