Healthcare Provider Details

I. General information

NPI: 1235150400
Provider Name (Legal Business Name): CAPITOL NEPHROLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 UNIVERSITY AVE STE 120
SACRAMENTO CA
95825-6532
US

IV. Provider business mailing address

1111 EXPOSITION BLVD STE 300
SACRAMENTO CA
95815-4324
US

V. Phone/Fax

Practice location:
  • Phone: 916-929-8564
  • Fax: 916-929-4529
Mailing address:
  • Phone: 916-929-8564
  • Fax: 916-929-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINA M TANI
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 916-426-1949