Provider Demographics
NPI:1134530405
Name:PREMIER OB GYN NAPA, INC
Entity type:Organization
Organization Name:PREMIER OB GYN NAPA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY GANTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-270-7518
Mailing Address - Street 1:3030 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3490
Mailing Address - Country:US
Mailing Address - Phone:516-270-7518
Mailing Address - Fax:707-257-2006
Practice Address - Street 1:3030 BEARD RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3490
Practice Address - Country:US
Practice Address - Phone:516-270-7518
Practice Address - Fax:707-257-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8707207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY43G431Medicare PIN
NYG54340Medicare UPIN