Healthcare Provider Details

I. General information

NPI: 1215543178
Provider Name (Legal Business Name): ALLIED MEDICAL & DIAGNOSTIC GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 HOSPITAL DR STE J
SACRAMENTO CA
95823-5406
US

IV. Provider business mailing address

7600 HOSPITAL DR STE J
SACRAMENTO CA
95823-5406
US

V. Phone/Fax

Practice location:
  • Phone: 916-525-2021
  • Fax:
Mailing address:
  • Phone: 916-525-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA JORDAN
Title or Position: PROVIDER
Credential:
Phone: 916-525-2021