Healthcare Provider Details

I. General information

NPI: 1932691797
Provider Name (Legal Business Name): VASCULAR INSTITUTE OF NORTHERN CALIFORNIA, A PODIATRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY AVE STE 250
SACRAMENTO CA
95825-6525
US

IV. Provider business mailing address

635 ANDERSON RD STE 4
DAVIS CA
95616-3505
US

V. Phone/Fax

Practice location:
  • Phone: 916-235-9100
  • Fax: 916-680-9550
Mailing address:
  • Phone: 530-979-6226
  • Fax: 530-758-1896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACY L BASSO
Title or Position: OWNER
Credential:
Phone: 916-235-9100