| Glutality Provider Group Of California Pc | |
|
7250 Redwood Blvd Ste 300 Novato CA 94945-3269 | |
| (561) 678-2026 | |
| (561) 423-9249 |
| Full Name | Glutality Provider Group Of California Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7250 Redwood Blvd Ste 300, Novato, California |
| Authorized Official Name and Position | Mark Mitchell (OWNER) |
| Authorized Official Contact | 5616782026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glutality Provider Group Of California Pc 401 Fairway Dr Ste 200 Deerfield Beach FL 33441-1800 Ph: (561) 678-2026 | Glutality Provider Group Of California Pc 7250 Redwood Blvd Ste 300 Novato CA 94945-3269 Ph: (561) 678-2026 |
| NPI Number | 1235843723 |
|---|---|
| Provider Enumeration Date | 01/09/2023 |
| Last Update Date | 01/09/2023 |
| Medicare PECOS PAC ID | 3870957046 |
|---|---|
| Medicare Enrollment ID | O20230907001074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235843723 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Corey Brown |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487944617 PECOS PAC ID: 8224281019 Enrollment ID: I20131112000462 |
| Provider Name | Anshul M Gandhi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396177564 PECOS PAC ID: 4981832185 Enrollment ID: I20161003002050 |
| Provider Name | Nicholas A Raubitschek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093101248 PECOS PAC ID: 6002122124 Enrollment ID: I20180911002459 |
| Provider Name | Ellena Lois Boddie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689673790 PECOS PAC ID: 0840399515 Enrollment ID: I20210420001712 |
| Provider Name | Daniel G Funsch |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023471547 PECOS PAC ID: 2365789039 Enrollment ID: I20220714002140 |
| Provider Name | Mark Mitchell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003833633 PECOS PAC ID: 2264333632 Enrollment ID: I20231027001988 |
| Provider Name | Erik Deede |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821036112 PECOS PAC ID: 5092889808 Enrollment ID: I20231115001967 |
| Provider Name | Robert Edward Hurd |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720015787 PECOS PAC ID: 4082895461 Enrollment ID: I20231127002134 |
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Veterans Administration Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7 Lavenham Rd, Novato, CA 94949 Phone: 415-218-1435 | |
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