Healthcare Provider Details

I. General information

NPI: 1821409178
Provider Name (Legal Business Name): SENIOR CARE CLINIC HOUSE CALLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 06/21/2020
Certification Date: 06/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 LINCOLN BLVD SUITE 100
LINCOLN CA
95648-6315
US

IV. Provider business mailing address

89 LINCOLN BLVD SUITE 100
LINCOLN CA
95648-6315
US

V. Phone/Fax

Practice location:
  • Phone: 916-543-1593
  • Fax:
Mailing address:
  • Phone: 916-543-1593
  • Fax: 877-466-7829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberFNP543348
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberFNP543348
License Number StateCA

VIII. Authorized Official

Name: RON BILLANO ORDONA
Title or Position: CLINICIAN TEAM LEAD
Credential:
Phone: 916-543-1593