Healthcare Provider Details

I. General information

NPI: 1194455402
Provider Name (Legal Business Name): PALTM, MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 SAN YSIDRO WAY
SACRAMENTO CA
95864-2817
US

IV. Provider business mailing address

3641 SAN YSIDRO WAY
SACRAMENTO CA
95864-2817
US

V. Phone/Fax

Practice location:
  • Phone: 916-296-2194
  • Fax:
Mailing address:
  • Phone: 916-296-2194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MUNISH KUMAR
Title or Position: DIRECTOR
Credential: MD
Phone: 916-296-2194