Provider Demographics
NPI:1306302955
Name:ERIC D. BAVA, M.D. , INC.
Entity type:Organization
Organization Name:ERIC D. BAVA, M.D. , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORENNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-946-0020
Mailing Address - Street 1:1550G TIBURON BLVD # 416
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-2521
Mailing Address - Country:US
Mailing Address - Phone:626-437-4124
Mailing Address - Fax:
Practice Address - Street 1:1550G TIBURON BLVD # 416
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-2521
Practice Address - Country:US
Practice Address - Phone:626-437-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty