Healthcare Provider Details

I. General information

NPI: 1487856050
Provider Name (Legal Business Name): MARC MASKOWITZ MD, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 HOWE AVE SUITE 225
SACRAMENTO CA
95825-3365
US

IV. Provider business mailing address

1321 HOWE AVE SUITE 225
SACRAMENTO CA
95825-3365
US

V. Phone/Fax

Practice location:
  • Phone: 916-564-2225
  • Fax: 916-564-5926
Mailing address:
  • Phone: 916-564-2225
  • Fax: 916-564-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA97386
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA97386
License Number StateCA

VIII. Authorized Official

Name: DR. MARC MASKOWITZ
Title or Position: PRESIDENT
Credential: MD
Phone: 916-564-2225