Healthcare Provider Details

I. General information

NPI: 1104895440
Provider Name (Legal Business Name): VA NCHCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

11400 SABALO WAY
GOLD RIVER CA
95670-6206
US

V. Phone/Fax

Practice location:
  • Phone: 916-366-5406
  • Fax: 916-843-7323
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA81456
License Number StateCA

VIII. Authorized Official

Name: DAVID SIEGAL
Title or Position: CHIEF, MEDICINE SERVICE
Credential:
Phone: 916-843-7096