Healthcare Provider Details

I. General information

NPI: 1134490493
Provider Name (Legal Business Name): MED 9 CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 STOCKTON BLVD
SACRAMENTO CA
95816-6638
US

IV. Provider business mailing address

1936 STOCKTON BLVD
SACRAMENTO CA
95816-6638
US

V. Phone/Fax

Practice location:
  • Phone: 916-732-9032
  • Fax:
Mailing address:
  • Phone: 916-732-9032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberC28231
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL SCHORR
Title or Position: PRESIDENT
Credential: MD
Phone: 916-732-9032