Provider Demographics
NPI:1891801122
Name:BAY AREA GYNECOLOGY ONCOLOGY
Entity type:Organization
Organization Name:BAY AREA GYNECOLOGY ONCOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:LILJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-827-4274
Mailing Address - Street 1:PO BOX 33235
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031-3235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:910 CAMPISI WAY STE 2A
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2351
Practice Address - Country:US
Practice Address - Phone:408-827-4274
Practice Address - Fax:408-827-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA068842174400000X
CAG85643174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG85643OtherLICENSE DR. LILJA
CA00A068842Medicaid
CAA068842OtherLICENSE DR. MANUEL
CA00G856431Medicaid
CA00G856431Medicaid
CA=========OtherTAX ID NUMBER
CAH18658Medicare UPIN
CAA068842OtherLICENSE DR. MANUEL