MEDICARE: PREMIER OB GYN NAPA, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	20A8707	CA

General Provider Information

NPI Number	:	1134530405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER OB GYN NAPA, INC

Provider Business Mailing Address
First Line	:	3030 BEARD RD
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94558-3490
Country	:	US
Telephone Number	:	516-270-7518
Fax Number	:	707-257-2006

Provider Business Practice Location Address
First Line	:	3030 BEARD RD
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94558-3490
Country	:	US
Telephone Number	:	516-270-7518
Fax Number	:	707-257-2006

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	MRS. REBECCA LEVY GANTT
Credential	:	D.O.
Telephone Number	:	516-270-7518

Provider Enumeration Date	:	05/08/2014
Last Update Date	:	05/08/2014

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