Healthcare Provider Details

I. General information

NPI: 1356322150
Provider Name (Legal Business Name): NATHAN KUPPERMANN M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD PSSB SUITE 2100
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2315 STOCKTON BLVD PSSB SUITE 2100
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-1535
  • Fax: 916-734-7950
Mailing address:
  • Phone: 916-734-1535
  • Fax: 916-734-7950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG58501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: