Healthcare Provider Details

I. General information

NPI: 1730277344
Provider Name (Legal Business Name): NCSRA MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 K ST SUITE 410
SACRAMENTO CA
95816-5119
US

IV. Provider business mailing address

2 SCRIPPS DR STE 310
SACRAMENTO CA
95825-6207
US

V. Phone/Fax

Practice location:
  • Phone: 916-389-7100
  • Fax: 916-389-7140
Mailing address:
  • Phone: 916-389-7130
  • Fax: 916-389-7140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHENNA KAUFUSI
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 916-389-7130