Healthcare Provider Details

I. General information

NPI: 1992988513
Provider Name (Legal Business Name): SA HAGGERTY, INC., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 ELVAS AVE
SACRAMENTO CA
95819-2332
US

IV. Provider business mailing address

1416 TOWSE DR
WOODLAND CA
95776-6715
US

V. Phone/Fax

Practice location:
  • Phone: 916-739-1507
  • Fax:
Mailing address:
  • Phone: 707-365-7640
  • Fax: 815-361-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA98050
License Number StateCA

VIII. Authorized Official

Name: DR. SHERYL ANN HAGGERTY
Title or Position: CEO
Credential: M.D.
Phone: 707-365-7640