Provider Demographics
NPI:1629094032
Name:BACAY, BERNARD SONGCO (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:SONGCO
Last Name:BACAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 NORMAN DR
Mailing Address - Street 2:STE 103
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5900
Mailing Address - Country:US
Mailing Address - Phone:209-825-6331
Mailing Address - Fax:209-825-6351
Practice Address - Street 1:1140 NORMAN DR
Practice Address - Street 2:STE 103
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5900
Practice Address - Country:US
Practice Address - Phone:209-825-6331
Practice Address - Fax:209-825-6351
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0099130Medicaid
CAGR0099130Medicaid