Healthcare Provider Details

I. General information

NPI: 1194871152
Provider Name (Legal Business Name): NIVANO PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 RIVER PARK DR STE 200
SACRAMENTO CA
95815
US

IV. Provider business mailing address

PO BOX 255568
SACRAMENTO CA
95865-5568
US

V. Phone/Fax

Practice location:
  • Phone: 916-407-2000
  • Fax:
Mailing address:
  • Phone: 916-407-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: YOLANDA GARCIA
Title or Position: CONTRACT MANAGER
Credential:
Phone: 916-245-2452