Provider Demographics
NPI:1710017371
Name:WOMENS HEALTH CENTER
Entity Type:Organization
Organization Name:WOMENS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNERSHIP
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:I
Authorized Official - Last Name:GUTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-964-0259
Mailing Address - Street 1:850 SEQUOIA CIR
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5490
Mailing Address - Country:US
Mailing Address - Phone:707-964-0259
Mailing Address - Fax:707-964-0765
Practice Address - Street 1:850 SEQUOIA CIR
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5490
Practice Address - Country:US
Practice Address - Phone:707-964-0259
Practice Address - Fax:707-964-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG229470207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABCP53847FMedicaid
CAG229470OtherERIC GUTNICKS LICENSE
CAYYY48956YMedicaid
CARHM53847FMedicaid
CAG19197OtherKEEVAN ABRAMSON LICENSE
CARHM53847FMedicaid
CAG19197OtherKEEVAN ABRAMSON LICENSE
CAA40562Medicare UPIN
CAYYY48956YMedicaid