Healthcare Provider Details

I. General information

NPI: 1659069672
Provider Name (Legal Business Name): NORTHERN CALIFORNIA P.E.T. IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3718 ATHERTON RD
ROCKLIN CA
95765-3717
US

IV. Provider business mailing address

3195 FOLSOM BLVD STE 110
SACRAMENTO CA
95816-5264
US

V. Phone/Fax

Practice location:
  • Phone: 916-737-3211
  • Fax: 916-737-6203
Mailing address:
  • Phone: 916-737-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANETTE HALEY
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 916-737-3214