Healthcare Provider Details

I. General information

NPI: 1659535102
Provider Name (Legal Business Name): NATARAJ SHANMUGAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 Q ST FL 1
SACRAMENTO CA
95816-7058
US

IV. Provider business mailing address

3400 DATA DR RADIOLOGY, 2ND FLOOR/ADMIN
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-3301
  • Fax: 916-281-3882
Mailing address:
  • Phone: 916-363-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberA115371
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number42869
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA115371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: