Healthcare Provider Details

I. General information

NPI: 1891182044
Provider Name (Legal Business Name): PRESTIGE BARIATRIC AND SURGICAL SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7551 TIMBERLAKE WAY STE 230
SACRAMENTO CA
95823-5422
US

IV. Provider business mailing address

9337 FEATHER FALLS WAY
ELK GROVE CA
95624-3980
US

V. Phone/Fax

Practice location:
  • Phone: 916-347-3630
  • Fax: 916-347-3632
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA106886
License Number StateCA

VIII. Authorized Official

Name: HSINJU RUBY GATSCHET
Title or Position: MD
Credential:
Phone: 559-285-1012