Provider Demographics
NPI:1982793196
Name:BAY FAMILY MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:BAY FAMILY MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN-CANTIGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-348-0454
Mailing Address - Street 1:50 S SAN MATEO DR STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3842
Mailing Address - Country:US
Mailing Address - Phone:650-340-6040
Mailing Address - Fax:650-348-7923
Practice Address - Street 1:50 S SAN MATEO DR STE 230
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3842
Practice Address - Country:US
Practice Address - Phone:650-348-0454
Practice Address - Fax:650-348-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-29877982OtherDR. ALEXANDER MOLDANADO
CAZZZ141372OtherMICHELE LOBITZ, FNP
CA=========OtherDR. KRISTEN WILLISON
CA94-29877982OtherDR. ALEXANDER MOLDANADO
CA=========OtherMICHELE LOBITZ, FNP
CA94-29877982OtherDR. ALEXANDER MOLDANADO
CAF99578Medicare UPIN
CAF06068Medicare UPIN
CAZZZ14137ZMedicare ID - Type UnspecifiedMICHELE LOBITZ, FNP