Healthcare Provider Details

I. General information

NPI: 1063809861
Provider Name (Legal Business Name): SACRAMENTO PSYCHIATRY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8009 BRUCEVILLE RD SUITE 100
SACRAMENTO CA
95823-2332
US

IV. Provider business mailing address

10270 E TARON DR UNIT 35
ELK GROVE CA
95757-8222
US

V. Phone/Fax

Practice location:
  • Phone: 916-716-4148
  • Fax:
Mailing address:
  • Phone: 916-716-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number131310
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number131310
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number131310
License Number StateCA

VIII. Authorized Official

Name: ALOK BANGA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 916-716-4148