Healthcare Provider Details

I. General information

NPI: 1629131883
Provider Name (Legal Business Name): SACRAMENTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9616 MICRON AVE SUITE 850B
SACRAMENTO CA
95827-2625
US

IV. Provider business mailing address

9616 MICRON AVE SUITE 850B
SACRAMENTO CA
95827-2625
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-9847
  • Fax: 916-875-9833
Mailing address:
  • Phone: 916-875-9847
  • Fax: 916-875-9833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberC42535
License Number StateCA

VIII. Authorized Official

Name: DR. KEITH ANDREWS
Title or Position: CHIEF PRIMARY CARE DIVISION
Credential: M.D.
Phone: 916-875-5701