Healthcare Provider Details

I. General information

NPI: 1679809032
Provider Name (Legal Business Name): HYPERBARIC OXYGEN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 STOCKTON BLVD
SACRAMENTO CA
95816-6638
US

IV. Provider business mailing address

3104 O ST SUITE #375
SACRAMENTO CA
95816-6519
US

V. Phone/Fax

Practice location:
  • Phone: 916-420-2673
  • Fax: 415-520-6881
Mailing address:
  • Phone: 916-420-2673
  • Fax: 415-520-6881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberC52426
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL GREENHALGH
Title or Position: MANAGER
Credential:
Phone: 916-420-2673