Provider Demographics
NPI:1730413774
Name:BOB GHELFI MD PC
Entity type:Organization
Organization Name:BOB GHELFI MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GHELFI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:866-972-5302
Mailing Address - Street 1:2295 GATEWAY OAKS DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3225
Mailing Address - Country:US
Mailing Address - Phone:866-972-5302
Mailing Address - Fax:866-972-5303
Practice Address - Street 1:2295 GATEWAY OAKS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-3225
Practice Address - Country:US
Practice Address - Phone:866-972-5302
Practice Address - Fax:866-972-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty