Healthcare Provider Details

I. General information

NPI: 1093012775
Provider Name (Legal Business Name): SACRAMENTO OCCUPATIONAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BUSINESS PARK WAY STE 111
SACRAMENTO CA
95828-0959
US

IV. Provider business mailing address

15 BUSINESS PARK WAY STE 111
SACRAMENTO CA
95828-0959
US

V. Phone/Fax

Practice location:
  • Phone: 916-387-6929
  • Fax:
Mailing address:
  • Phone: 916-387-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID ROOT
Title or Position: MEDICAL DIRECTOR
Credential: M.D., M.P.H
Phone: 916-387-6929