Healthcare Provider Details

I. General information

NPI: 1801267604
Provider Name (Legal Business Name): FAMILY PSYCHIATRY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8009 BRUCEVILLE RD STE 102
SACRAMENTO CA
95823-2332
US

IV. Provider business mailing address

10067 WYATT RANCH WAY
SACRAMENTO CA
95829-8003
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA131310
License Number StateCA

VIII. Authorized Official

Name: ALOK BANGA
Title or Position: CEO
Credential: MD
Phone: 916-716-4148