Healthcare Provider Details

I. General information

NPI: 1922115575
Provider Name (Legal Business Name): SACRAMENTO KNEE & SPORTS MEDICINE MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 K ST STE 310
SACRAMENTO CA
95816
US

IV. Provider business mailing address

2801 K ST STE 310
SACRAMENTO CA
95816-5119
US

V. Phone/Fax

Practice location:
  • Phone: 916-454-6677
  • Fax: 916-733-8741
Mailing address:
  • Phone: 916-454-6677
  • Fax: 916-733-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: EVELYN L RODRIGUEZ
Title or Position: FINANCIAL ADMINISTRATOR
Credential:
Phone: 916-454-6677