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Organization
BAY VALLEY MEDICAL GROUP, INC
Active
Organization
BAY VALLEY MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW BURDUSIS (MANAGER OF INFORMATION SYSTEMS)
(510) 785-5000
Entity
Organization
Contact information
Practice address
27212 CALAROGA AVE, HAYWARD, CA 94545-4339
(510) 785-5000
(510) 293-5606
Mailing address
27212 CALAROGA AVE, HAYWARD, CA 94545-4339
(510) 785-5000
(510) 293-5606
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
—
NULL
106H00000X
Marriage & Family Therapist
—
—
207P00000X
Emergency Medicine Physician
—
NULL
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
NULL
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
NULL
208800000X
Urology Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
213E00000X
Podiatrist
—
NULL
213E00000X
Podiatrist
—
—
291U00000X
Clinical Medical Laboratory
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0599092
CLIA
CA
01
—
GR0024010
MEDICAL PROVIDER NUMBER
CA
01
—
ZZZ81610Z
MEDICAL LAB PROVIDER NUMBER
CA
Enumeration date
07/21/2006
Last updated
04/29/2008
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