Provider Demographics
NPI:1689782039
Name:EAST BAY CENTER FOR DIGESTIVE HEALTH MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:EAST BAY CENTER FOR DIGESTIVE HEALTH MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-433-7821
Mailing Address - Street 1:300 FRANK H OGAWA PLZ STE 355
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2088
Mailing Address - Country:US
Mailing Address - Phone:510-444-3297
Mailing Address - Fax:510-444-6421
Practice Address - Street 1:300 FRANK H OGAWA PLZ
Practice Address - Street 2:SUITE 450
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2037
Practice Address - Country:US
Practice Address - Phone:510-444-3297
Practice Address - Fax:510-444-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0082090Medicaid
CAGF0082090Medicaid