Healthcare Provider Details

I. General information

NPI: 1649471798
Provider Name (Legal Business Name): PRENATAL DIAGNOSIS OF NORTHERN CALIFORNIA MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 EXPOSITION BLVD. BLDG. 200
SACRAMENTO CA
95815-4324
US

IV. Provider business mailing address

1111 EXPOSITION BLVD. BLDG. 200
SACRAMENTO CA
95815-4324
US

V. Phone/Fax

Practice location:
  • Phone: 916-736-6888
  • Fax: 916-779-3260
Mailing address:
  • Phone: 916-736-6888
  • Fax: 916-779-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF10469
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number189620
License Number StateCA

VIII. Authorized Official

Name: DOUGLAS HERSHEY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 916-736-6888