Healthcare Provider Details

I. General information

NPI: 1194607465
Provider Name (Legal Business Name): CAPITOL MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 WILLOW CREEK WAY
ROCKLIN CA
95765-5782
US

IV. Provider business mailing address

4115 WILLOW CREEK WAY
ROCKLIN CA
95765-5782
US

V. Phone/Fax

Practice location:
  • Phone: 916-938-9280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAYANTH TALLURI
Title or Position: MD
Credential:
Phone: 916-938-9280