Organization
BAY AREA NEURO CLINIC INC
Active
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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