Healthcare Provider Details

I. General information

NPI: 1033732151
Provider Name (Legal Business Name): TRAVIS LOIDOLT DO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 E BIDWELL ST
FOLSOM CA
95630-3463
US

IV. Provider business mailing address

2220 E BIDWELL ST
FOLSOM CA
95630-3463
US

V. Phone/Fax

Practice location:
  • Phone: 916-800-4685
  • Fax: 916-512-3901
Mailing address:
  • Phone: 916-800-4685
  • Fax: 916-512-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: LIZ SCRIVEN
Title or Position: CREDENTIALING
Credential:
Phone: 209-409-2585