Healthcare Provider Details

I. General information

NPI: 1467444711
Provider Name (Legal Business Name): NORTHERN CALIFORNIA CARDIOLOGY ASSOCIATES MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 F ST #117
SACRAMENTO CA
95819-3226
US

IV. Provider business mailing address

1330 21ST STREET #201 C/O MIDTOWN FINANCIAL
SACRAMENTO CA
95811-4231
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-1788
  • Fax: 916-733-1787
Mailing address:
  • Phone: 916-561-6848
  • Fax: 916-447-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number207RC0001X
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number207R10011X
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number207UN0901X
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number207RC0000X
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM R. VETTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 916-733-1788