Provider Demographics
NPI:1053412403
Name:HEAD, BOBBIE (MD, PHD)
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:
Last Name:HEAD
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 S ELISEO DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2011
Mailing Address - Country:US
Mailing Address - Phone:415-925-5000
Mailing Address - Fax:415-925-5050
Practice Address - Street 1:1350 S ELISEO DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2011
Practice Address - Country:US
Practice Address - Phone:415-925-5000
Practice Address - Fax:415-925-5050
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50943174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG50943OtherSTATE LICENSE
CA00G509430Medicaid
CA00G509430Medicare ID - Type Unspecified
CAE47733Medicare UPIN