Healthcare Provider Details

I. General information

NPI: 1114509395
Provider Name (Legal Business Name): MS. BEATRIZ AURORA OLMEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 CENTER PKWY
SACRAMENTO CA
95823-5704
US

IV. Provider business mailing address

1050 20TH ST STE 200
SACRAMENTO CA
95811-3155
US

V. Phone/Fax

Practice location:
  • Phone: 530-650-2711
  • Fax:
Mailing address:
  • Phone: 916-307-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License NumberNBC-22081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: