Healthcare Provider Details

I. General information

NPI: 1285544163
Provider Name (Legal Business Name): CAPITAL CITY MEDICAL MONITORING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5346 MADISON AVE STE DANDE
SACRAMENTO CA
95841-3166
US

IV. Provider business mailing address

5346 MADISON AVE STE DANDE
SACRAMENTO CA
95841-3166
US

V. Phone/Fax

Practice location:
  • Phone: 916-964-6480
  • Fax: 916-964-6481
Mailing address:
  • Phone: 916-964-6480
  • Fax: 916-964-6481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER USOROV
Title or Position: CEO
Credential: MD
Phone: 720-255-7016