Healthcare Provider Details

I. General information

NPI: 1790798908
Provider Name (Legal Business Name): ROCKLIN FAMILY PRACTICE AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 SUNSET BLVD #2B
ROCKLIN CA
95677
US

IV. Provider business mailing address

3104 SUNSET BLVD #2B
ROCKLIN CA
95677
US

V. Phone/Fax

Practice location:
  • Phone: 916-624-0300
  • Fax: 916-624-0631
Mailing address:
  • Phone: 916-624-0300
  • Fax: 916-624-0631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROY MC HARRIS
Title or Position: PRESIDENT
Credential: MD
Phone: 916-624-0300