Healthcare Provider Details

I. General information

NPI: 1477474807
Provider Name (Legal Business Name): PLACER PSYCHIATRY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5157 PRIOR RDG
GRANITE BAY CA
95746-7187
US

IV. Provider business mailing address

5157 PRIOR RDG
GRANITE BAY CA
95746-7187
US

V. Phone/Fax

Practice location:
  • Phone: 916-644-6474
  • Fax:
Mailing address:
  • Phone: 916-644-6474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN DAVID FUNK
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 916-644-6474