Provider Demographics
NPI:1730136680
Name:CAPITAL OB/GYN, INC.
Entity Type:Organization
Organization Name:CAPITAL OB/GYN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-920-2109
Mailing Address - Street 1:77 CADILLAC DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-5453
Mailing Address - Country:US
Mailing Address - Phone:916-920-2082
Mailing Address - Fax:916-920-1430
Practice Address - Street 1:77 CADILLAC DR
Practice Address - Street 2:SUITE 230
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-5453
Practice Address - Country:US
Practice Address - Phone:916-920-2082
Practice Address - Fax:916-920-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101650Medicaid