Basic Information
| Provider Information | |||||||||
| NPI: | 1710397369 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAY AREA CHILDREN'S ASSOCIATION OAKLAND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 SARATOGA AVE | ||||||||
| Address2: | SUITE 14 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951293440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089967950 | ||||||||
| FaxNumber: | 4089967997 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 MYRTLE ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946072525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109229757 | ||||||||
| FaxNumber: | 5109229514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2014 | ||||||||
| LastUpdateDate: | 05/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | MUNIZ | ||||||||
| AuthorizedOfficialFirstName: | BRANDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4089967950 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAY AREA CHILDREN'S ASSOCIATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 2084P0804X | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.