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General NPI Number Information
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NPI Number | 1144044397
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Entity Type | Organization
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Legal Business Name | GHOAT LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 825 K ST STE 200
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City | SACRAMENTO
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State | CA
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Zip | 95814-3547
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Country | US
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Telephone | 916-412-1156
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Fax |
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Provider Business Mailing Address
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Address Line | 825 K ST STE 200
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City | SACRAMENTO
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State | CA
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Zip | 95814-3547
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Country | US
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Telephone | 916-412-1156
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MR. TYLER SMITH
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Credential |
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Telephone | 916-412-1156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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