Healthcare Provider Details

I. General information

NPI: 1871603258
Provider Name (Legal Business Name): ACACIA FAMILY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E ROMIE LN
SALINAS CA
93901-4017
US

IV. Provider business mailing address

400 E ROMIE LN
SALINAS CA
93901-4017
US

V. Phone/Fax

Practice location:
  • Phone: 831-770-0123
  • Fax: 831-770-1599
Mailing address:
  • Phone: 831-770-0123
  • Fax: 831-770-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUMANA REDDY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 831-770-0123