Healthcare Provider Details

I. General information

NPI: 1306489687
Provider Name (Legal Business Name): JAMES LONGORIA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2019
Last Update Date: 10/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 L ST STE 200
SACRAMENTO CA
95816-5616
US

IV. Provider business mailing address

2443 FAIR OAKS BLVD # 244
SACRAMENTO CA
95825-7684
US

V. Phone/Fax

Practice location:
  • Phone: 916-456-4428
  • Fax:
Mailing address:
  • Phone: 916-717-0187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES LONGORIA
Title or Position: OWNER
Credential: MD
Phone: 916-717-0187