Healthcare Provider Details

I. General information

NPI: 1144044397
Provider Name (Legal Business Name): GHOAT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 K ST STE 200
SACRAMENTO CA
95814-3547
US

IV. Provider business mailing address

825 K ST STE 200
SACRAMENTO CA
95814-3547
US

V. Phone/Fax

Practice location:
  • Phone: 916-412-1156
  • Fax:
Mailing address:
  • Phone: 916-412-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TYLER SMITH
Title or Position: SOLE MEMBER
Credential:
Phone: 916-412-1156