Healthcare Provider Details

I. General information

NPI: 1194090654
Provider Name (Legal Business Name): EDINGTON MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 UNIVERSITY AVE SUITE 140
SACRAMENTO CA
95825-6520
US

IV. Provider business mailing address

425 UNIVERSITY AVE SUITE 140
SACRAMENTO CA
95825-6520
US

V. Phone/Fax

Practice location:
  • Phone: 916-920-1222
  • Fax: 916-920-3222
Mailing address:
  • Phone: 916-920-1222
  • Fax: 916-920-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD BALDINI
Title or Position: GENERAL MANAGER
Credential:
Phone: 916-576-2957