Healthcare Provider Details

I. General information

NPI: 1265832166
Provider Name (Legal Business Name): ALBERTO PANERO DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 FAIR OAKS BLVD STE 415
SACRAMENTO CA
95825-5500
US

IV. Provider business mailing address

2277 FAIR OAKS BLVD STE 415
SACRAMENTO CA
95825-5500
US

V. Phone/Fax

Practice location:
  • Phone: 916-418-4442
  • Fax: 916-256-3968
Mailing address:
  • Phone: 916-418-4442
  • Fax: 916-256-3968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A12853
License Number StateCA

VIII. Authorized Official

Name: ALBERTO JAVIER PANERO
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 916-418-4442