Healthcare Provider Details

I. General information

NPI: 1093767063
Provider Name (Legal Business Name): SACRAMENTO HEART & VASCULAR MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY AVE
SACRAMENTO CA
95825-6523
US

IV. Provider business mailing address

500 UNIVERSITY AVE
SACRAMENTO CA
95825-6523
US

V. Phone/Fax

Practice location:
  • Phone: 916-830-2000
  • Fax:
Mailing address:
  • Phone: 916-830-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: TERESA L ISIDORE
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 916-830-2041