Healthcare Provider Details

I. General information

NPI: 1508936030
Provider Name (Legal Business Name): COUNTY OF SACRAMENTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BROADWAY STE 1300
SACRAMENTO CA
95820-1527
US

IV. Provider business mailing address

7001-A EAST PARKWAY STE. 600
SACRAMENTO CA
95823-2501
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-9823
  • Fax: 916-874-9442
Mailing address:
  • Phone: 916-875-5881
  • Fax: 916-875-6366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number05D0616630
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. QUAITA L. STUCKER
Title or Position: SENIOR ACCOUNT CLERK
Credential:
Phone: 916-875-1416