Organization
BAY AREA COMMITTED TO KIDS MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMIE ELISE WALLACH M.D. (PRESIDENT/OWNER)
(510) 336-0880
Entity
Organization
Contact information
Practice address
3306 HERRIER ST, OAKLAND, CA 94602-4004
(510) 336-0880
Mailing address
3306 HERRIER ST, OAKLAND, CA 94602-4004
(510) 336-0880
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G79903
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912186834
—
CA
Enumeration date
10/27/2007
Last updated
12/29/2010
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