Healthcare Provider Details

I. General information

NPI: 1770218935
Provider Name (Legal Business Name): NCFMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 AUBURN BLVD
SACRAMENTO CA
95841-4166
US

IV. Provider business mailing address

4320 AUBURN BLVD
SACRAMENTO CA
95841-4166
US

V. Phone/Fax

Practice location:
  • Phone: 916-773-2229
  • Fax: 916-773-8391
Mailing address:
  • Phone: 916-773-2229
  • Fax: 916-773-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE MARIE KOENES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 916-773-2229