Healthcare Provider Details

I. General information

NPI: 1942963442
Provider Name (Legal Business Name): NIGHTWATER HEALTH OF CALIFORNIA APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 SCRIPPS DR STE 100
SACRAMENTO CA
95825-6379
US

IV. Provider business mailing address

111 WATER ST STE 4
EXETER NH
03833-2456
US

V. Phone/Fax

Practice location:
  • Phone: 916-415-7010
  • Fax: 916-244-0100
Mailing address:
  • Phone: 603-247-5442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL IKEMIRE
Title or Position: CEO
Credential:
Phone: 916-500-8086