Basic Information
| Provider Information | |||||||||
| NPI: | 1134530405 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER OB GYN NAPA, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3030 BEARD RD | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945583490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162707518 | ||||||||
| FaxNumber: | 7072572006 | ||||||||
| Practice Location | |||||||||
| Address1: | 3030 BEARD RD | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945583490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162707518 | ||||||||
| FaxNumber: | 7072572006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2014 | ||||||||
| LastUpdateDate: | 05/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | LEVY GANTT | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5162707518 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 20A8707 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.