Healthcare Provider Details

I. General information

NPI: 1497758155
Provider Name (Legal Business Name): SACRAMENTO EAR NOSE & THROAT SURGICAL & MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 EXPOSITION BLVD BLDG 700
SACRAMENTO CA
95815-4300
US

IV. Provider business mailing address

1111 EXPOSITION BLVD BLDG 700
SACRAMENTO CA
95815-4300
US

V. Phone/Fax

Practice location:
  • Phone: 916-736-6670
  • Fax: 916-233-4171
Mailing address:
  • Phone: 916-736-3399
  • Fax: 916-233-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TERRI WEBER
Title or Position: CFO
Credential:
Phone: 916-736-3399