Healthcare Provider Details

I. General information

NPI: 1386286979
Provider Name (Legal Business Name): CALIFORNIA MATERNAL FETAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOWE AVE STE 186N
SACRAMENTO CA
95825-8219
US

IV. Provider business mailing address

1645 CREEKSIDE DR
FOLSOM CA
95630-3832
US

V. Phone/Fax

Practice location:
  • Phone: 916-603-5600
  • Fax: 855-815-4684
Mailing address:
  • Phone: 916-603-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANA ALLEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 916-603-5600