Healthcare Provider Details

I. General information

NPI: 1144451717
Provider Name (Legal Business Name): PEARL GROUP MEDICAL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5531 HEMLOCK ST
SACRAMENTO CA
95841-2709
US

IV. Provider business mailing address

5531 HEMLOCK ST
SACRAMENTO CA
95841-2709
US

V. Phone/Fax

Practice location:
  • Phone: 916-339-2222
  • Fax:
Mailing address:
  • Phone: 916-339-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberW20501
License Number StateCA

VIII. Authorized Official

Name: ALICE MEYLER
Title or Position: OWNER
Credential: MD
Phone: 310-312-1111