Healthcare Provider Details

I. General information

NPI: 1912270281
Provider Name (Legal Business Name): PEDIATRIX CARDIOLOGY OF SACRAMENTO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5609 J ST SUITE A
SACRAMENTO CA
95819-3957
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 800-463-6628
  • Fax:
Mailing address:
  • Phone: 954-384-0175
  • Fax: 954-858-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY TWIGGS
Title or Position: REGIONAL PRESIDENT
Credential: MD
Phone: 800-243-3839