Organization Name: | SACRAMENTO FAMILY MEDICAL CLINIC |
NPI Number: | 1962647529 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GILBERT SIMON (OWNER) |
Mailing Address: | 9717 Elk Grove Florin Rd Ste A Elk Grove |
State: | CA US |
Postal Code: | 956242262 |
Phone Number: | 9167147400 |
Fax Number: | 9167147410 |
NPI Enumeration Date: | 12/11/2008 |
NPI Last Update Date: | 12/11/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 10-00008104 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |