Organization
BAY AREA NEURO CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE VICENTE BUSTAMANTE LICENSE MASSAGE THER (PRESIDENT)
(813) 985-3773
Entity
Organization
Contact information
Practice address
6275 E FOWLER AVE, TEMPLE TERRACE, FL 33617
(813) 985-3773
(813) 984-7171
Mailing address
6275 E FOWLER AVE, TEMPLE TERRACE, FL 33617
(813) 985-3773
(813) 984-7171
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C5112
BCBS
FL
Enumeration date
12/20/2006
Last updated
08/22/2020
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