Healthcare Provider Details

I. General information

NPI: 1538658844
Provider Name (Legal Business Name): NIGHTINGALE MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 ANDERSON RD STE 19
DAVIS CA
95616-3505
US

IV. Provider business mailing address

635 ANDERSON RD STE 19
DAVIS CA
95616-3505
US

V. Phone/Fax

Practice location:
  • Phone: 530-424-9900
  • Fax:
Mailing address:
  • Phone: 530-424-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACY L BASSO
Title or Position: VICE PRESIDENT
Credential: DPM
Phone: 530-979-6226