Healthcare Provider Details

I. General information

NPI: 1851798367
Provider Name (Legal Business Name): SACRAMENTO VALLEY PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 BRUCEVILLE RD
SACRAMENTO CA
95823-2329
US

IV. Provider business mailing address

8001 BRUCEVILLE RD
SACRAMENTO CA
95823-2329
US

V. Phone/Fax

Practice location:
  • Phone: 413-433-1562
  • Fax:
Mailing address:
  • Phone: 413-433-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ALOK BANGA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 413-433-1562