Healthcare Provider Details

I. General information

NPI: 1790135705
Provider Name (Legal Business Name): EHSAN SULTANI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 PARK TOWNE CIR
SACRAMENTO CA
95825-0414
US

IV. Provider business mailing address

2211 PARK TOWNE CIR
SACRAMENTO CA
95825-0414
US

V. Phone/Fax

Practice location:
  • Phone: 916-333-5977
  • Fax: 916-333-5972
Mailing address:
  • Phone: 916-333-5977
  • Fax: 916-333-5972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EHSAN SULTANI
Title or Position: OWNER
Credential: MD
Phone: 916-333-5977