Healthcare Provider Details

I. General information

NPI: 1750491122
Provider Name (Legal Business Name): KAREN ELIZABETH MARK M.D. MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 21ST ST
SACRAMENTO CA
95811-5216
US

IV. Provider business mailing address

PO BOX 997426 MS 7700
SACRAMENTO CA
95899-7426
US

V. Phone/Fax

Practice location:
  • Phone: 916-443-3299
  • Fax:
Mailing address:
  • Phone: 916-449-5895
  • Fax: 916-449-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA71951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: