Healthcare Provider Details

I. General information

NPI: 1245644863
Provider Name (Legal Business Name): UAP SACRAMENTO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 J ST 200
SACRAMENTO CA
95816-4307
US

IV. Provider business mailing address

5 HOLLAND 101
IRVINE CA
92618-2566
US

V. Phone/Fax

Practice location:
  • Phone: 916-231-8755
  • Fax:
Mailing address:
  • Phone: 949-588-2190
  • Fax: 949-588-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. NIRVANA KUNDU
Title or Position: AUTHORIZED OFFICIAL
Credential: M. D.
Phone: 530-665-3212