Organization
BAY VALLEY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW BURDUSIS (MANAGER OF INFORMATION SYSTEMS)
(510) 266-5401
Entity
Organization
Contact information
Practice address
20126 STANTON AVE, STE 201, CASTRO VALLEY, CA 94546-5271
(510) 581-2559
Mailing address
27212 CALAROGA AVE, HAYWARD, CA 94545-4339
(510) 785-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
213E00000X
Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0695762
CLIA
CA
01
—
05D1079934
CLIA
CA
01
—
GR0024011
MEDI-CAL
CA
Enumeration date
07/31/2006
Last updated
04/28/2008
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