Healthcare Provider Details

I. General information

NPI: 1285665620
Provider Name (Legal Business Name): JULIE MARIE GEBHARDT P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 DOUGLAS BLVD STE 325
ROSEVILLE CA
95661-4289
US

IV. Provider business mailing address

2276 SUMMER DR
EL DORADO HILLS CA
95762-6315
US

V. Phone/Fax

Practice location:
  • Phone: 916-241-9844
  • Fax: 916-241-9845
Mailing address:
  • Phone: 916-467-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number16078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: