Provider Demographics
NPI:1134867427
Name:OO, J RICHELCYN BACLAY (MD)
Entity type:Individual
Prefix:
First Name:J RICHELCYN
Middle Name:BACLAY
Last Name:OO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:J RICHELCYN
Other - Middle Name:MONTERO
Other - Last Name:BACLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:CJ HUANG BUILDING
Mailing Address - Street 2:780 WELCH ROAD, 3RD FLOOR
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304
Mailing Address - Country:US
Mailing Address - Phone:650-498-7387
Mailing Address - Fax:
Practice Address - Street 1:CJ HUANG BUILDING
Practice Address - Street 2:780 WELCH ROAD, 3RD FLOOR
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-498-7387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program