| Organization Name: | PLACER WELLNESS MEDICAL GROUP INC |
| NPI Number: | 1578889010 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAURA WILSON (CFO) |
| Mailing Address: | 6540 Lonetree Blvd Suite 200 Rocklin |
| State: | CA US |
| Postal Code: | 957655874 |
| Phone Number: | 9167973030 |
| Fax Number: | 9167970505 |
| NPI Enumeration Date: | 04/08/2010 |
| NPI Last Update Date: | 04/12/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A30174 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |