Provider Demographics
NPI:1194432799
Name:BAY AREA KETAMINE CENTER, INC.
Entity type:Organization
Organization Name:BAY AREA KETAMINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-529-4559
Mailing Address - Street 1:746 ALTOS OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5401
Mailing Address - Country:US
Mailing Address - Phone:415-529-4559
Mailing Address - Fax:855-967-2955
Practice Address - Street 1:746 ALTOS OAKS DR
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5401
Practice Address - Country:US
Practice Address - Phone:415-529-4559
Practice Address - Fax:855-967-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty