Healthcare Provider Details

I. General information

NPI: 1821286089
Provider Name (Legal Business Name): CRAIG BOBSON NORTH STREET FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 NORMAN DR SUITE 101
MANTECA CA
95336-5955
US

IV. Provider business mailing address

1140 NORMAN DR SUITE 101
MANTECA CA
95336-5955
US

V. Phone/Fax

Practice location:
  • Phone: 209-825-7748
  • Fax:
Mailing address:
  • Phone: 209-825-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CRAIG BOBSON
Title or Position: OWNER
Credential: M.D.
Phone: 209-825-7748