Healthcare Provider Details

I. General information

NPI: 1639062870
Provider Name (Legal Business Name): RIVER PEDIATRICS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 65TH ST
SACRAMENTO CA
95820-2057
US

IV. Provider business mailing address

3707 ORANGERIE WAY
CARMICHAEL CA
95608-2845
US

V. Phone/Fax

Practice location:
  • Phone: 530-564-8439
  • Fax:
Mailing address:
  • Phone: 520-444-2504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS GROSS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 530-219-8960