Healthcare Provider Details

I. General information

NPI: 1053346189
Provider Name (Legal Business Name): CAPITAL VASCULAR SURGEONS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 J ST
SACRAMENTO CA
95816-5520
US

IV. Provider business mailing address

3855 J ST
SACRAMENTO CA
95816-5520
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-0660
  • Fax: 916-733-0665
Mailing address:
  • Phone: 916-733-0660
  • Fax: 916-733-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD EDWARD WARD
Title or Position: PRESIDENT
Credential: MD
Phone: 916-733-0660