Healthcare Provider Details

I. General information

NPI: 1720649940
Provider Name (Legal Business Name): TRAVIS LOIDOLT D.O. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 N. SUNRISE AVE. SUITE 100
ROSEVILLE CA
95661-2862
US

IV. Provider business mailing address

2001 RATTLESNAKE RD.
NEWCASTLE CA
95658-9722
US

V. Phone/Fax

Practice location:
  • Phone: 916-800-4685
  • Fax: 916-512-3901
Mailing address:
  • Phone: 916-663-2100
  • Fax: 916-663-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TRAVIS LOIDOLT
Title or Position: MANAGING PHYSICIAN
Credential: D.O.
Phone: 916-800-4685