Provider Demographics
NPI:1124455282
Name:SOUTH BAY JOINT CARE INC
Entity type:Organization
Organization Name:SOUTH BAY JOINT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANGEETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALASUBRAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-866-1135
Mailing Address - Street 1:700 W PARR AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1442
Mailing Address - Country:US
Mailing Address - Phone:408-866-1135
Mailing Address - Fax:408-866-7926
Practice Address - Street 1:700 W PARR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1442
Practice Address - Country:US
Practice Address - Phone:408-866-1135
Practice Address - Fax:408-866-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA108621Medicare UPIN