Healthcare Provider Details

I. General information

NPI: 1841240454
Provider Name (Legal Business Name): SACRAMENTO CARDIOVASCULAR SURGEONS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 F ST STE 111
SACRAMENTO CA
95819-3226
US

IV. Provider business mailing address

5301 F ST STE 111
SACRAMENTO CA
95819-3226
US

V. Phone/Fax

Practice location:
  • Phone: 916-452-8291
  • Fax: 916-452-1733
Mailing address:
  • Phone: 916-452-8291
  • Fax: 916-452-1733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. GAIL L LOESCHER
Title or Position: BILLING MANAGER
Credential:
Phone: 916-451-5602