Healthcare Provider Details

I. General information

NPI: 1366513061
Provider Name (Legal Business Name): COUNTY OF SACRAMENTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/02/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BROADWAY SUITE 1100
SACRAMENTO CA
95820
US

IV. Provider business mailing address

4600 BROADWAY SUITE 2500
SACRAMENTO CA
95820
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-9670
  • Fax: 916-875-6366
Mailing address:
  • Phone: 916-875-5701
  • Fax: 916-854-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSMITA MISHRA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 916-874-9919