Organization Name: | CHILDREN'S MEDICAL CLINIC |
NPI Number: | 1821158114 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID L. BANNISTER (OWNER) |
Mailing Address: | 729 Sunrise Ave Suite 501 Roseville |
State: | CA US |
Postal Code: | 956614565 |
Phone Number: | 9167865800 |
Fax Number: | 9167733001 |
NPI Enumeration Date: | 12/10/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | G031541 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |