Healthcare Provider Details

I. General information

NPI: 1245249226
Provider Name (Legal Business Name): CAPITOL UROLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY AVE SUITE 200
SACRAMENTO CA
95825-6504
US

IV. Provider business mailing address

500 UNIVERSITY AVE SUITE 200
SACRAMENTO CA
95825-6504
US

V. Phone/Fax

Practice location:
  • Phone: 916-921-4530
  • Fax: 916-924-1611
Mailing address:
  • Phone: 916-921-4530
  • Fax: 916-924-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA37811
License Number StateNULL

VIII. Authorized Official

Name: KIUMARS R HEKMAT
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 916-921-4529