Provider Demographics
NPI:1932132297
Name:NORTH BAY PEDIATRICS
Entity Type:Organization
Organization Name:NORTH BAY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JADKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-648-0711
Mailing Address - Street 1:160 GLEN COVE MARINA RD #103
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591
Mailing Address - Country:US
Mailing Address - Phone:707-648-0711
Mailing Address - Fax:707-648-1306
Practice Address - Street 1:160 GLEN COVE MARINA RD #103
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591
Practice Address - Country:US
Practice Address - Phone:707-648-0711
Practice Address - Fax:707-648-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty