Provider Demographics
NPI:1962682062
Name:BAYSIDE MOBILE MEDICAL SERVICE
Entity Type:Organization
Organization Name:BAYSIDE MOBILE MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CRON
Authorized Official - Suffix:
Authorized Official - Credentials:CPT, CNA, EMT
Authorized Official - Phone:415-608-2174
Mailing Address - Street 1:390 BARTLETT ST APT 9
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3856
Mailing Address - Country:US
Mailing Address - Phone:415-608-2174
Mailing Address - Fax:925-849-4402
Practice Address - Street 1:390 BARTLETT ST APT 9
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3856
Practice Address - Country:US
Practice Address - Phone:415-608-2174
Practice Address - Fax:925-849-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT16284251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health