Provider Demographics
NPI:1922107564
Name:UNDERHILL, BOBBI S (DO)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:S
Last Name:UNDERHILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 J ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5562
Mailing Address - Country:US
Mailing Address - Phone:855-354-2242
Mailing Address - Fax:916-457-6227
Practice Address - Street 1:3701 J ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5562
Practice Address - Country:US
Practice Address - Phone:855-354-2242
Practice Address - Fax:916-457-6227
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7564208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01283856/DS9933OtherRAILROAD MEDICARE
CAP01453324-DV5277OtherRAILROAD MEDICARE
CA020A75640OtherMEDICARE PTAN
F85695Medicare UPIN
CA020A75640OtherMEDICARE PTAN
CAP01453324-DV5277OtherRAILROAD MEDICARE
CACA140766Medicare PIN