Provider Demographics
NPI:1487984670
Name:BRIAN BAI CLINIC
Entity type:Organization
Organization Name:BRIAN BAI CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASSELLIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-482-7260
Mailing Address - Street 1:1200 N VENTURA RD STE A
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3827
Mailing Address - Country:US
Mailing Address - Phone:805-485-7111
Mailing Address - Fax:805-485-7110
Practice Address - Street 1:1200 N VENTURA RD STE A
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3827
Practice Address - Country:US
Practice Address - Phone:805-485-7111
Practice Address - Fax:805-485-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144424102Medicaid
CADA109Medicare PIN