Provider Demographics
NPI:1780431106
Name:BAY AREA OCCUPATIONAL MEDICAL GROUP, PC
Entity type:Organization
Organization Name:BAY AREA OCCUPATIONAL MEDICAL GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALVERO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:831-277-2825
Mailing Address - Street 1:110 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5696
Mailing Address - Country:US
Mailing Address - Phone:408-882-3700
Mailing Address - Fax:669-230-5891
Practice Address - Street 1:110 N 3RD ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5696
Practice Address - Country:US
Practice Address - Phone:408-882-3700
Practice Address - Fax:669-230-5891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care