Healthcare Provider Details

I. General information

NPI: 1679620751
Provider Name (Legal Business Name): BENJAMIN BOBLETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 EL CAMINO REAL STE 160
BURLINGAME CA
94010-3224
US

IV. Provider business mailing address

577 AIRPORT BLVD STE 300
BURLINGAME CA
94010-2020
US

V. Phone/Fax

Practice location:
  • Phone: 650-259-1674
  • Fax:
Mailing address:
  • Phone: 650-240-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA69903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: