Organization
BAY AREA PEDIATRIC MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA L OCONNELL (MANAGER BUSINESS OFFICE)
(650) 994-1800
Entity
Organization
Contact information
Practice address
123 S SAN MATEO DR, SAN MATEO, CA 94401-3804
(650) 343-4200
(650) 343-5379
Mailing address
1500 SOUTHGATE AVE, SUITE 213, DALY CITY, CA 94015-2259
(650) 994-1800
(650) 994-1888
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0081923
—
CA
Enumeration date
11/29/2006
Last updated
08/22/2020
Update your record
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