Healthcare Provider Details

I. General information

NPI: 1114027950
Provider Name (Legal Business Name): CAROLINE ANNE PECK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 CAPITOL AVE STE 74.3.84
SACRAMENTO CA
95814-5052
US

IV. Provider business mailing address

PO BOX 997413 MS 7213
SACRAMENTO CA
95899-7413
US

V. Phone/Fax

Practice location:
  • Phone: 916-552-9940
  • Fax: 916-552-9994
Mailing address:
  • Phone: 916-552-9940
  • Fax: 916-552-9994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA056319
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA056319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: