Healthcare Provider Details

I. General information

NPI: 1831393255
Provider Name (Legal Business Name): VACAVILLE URGENT CARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NUT TREE RD STE 110
VACAVILLE CA
95687-4166
US

IV. Provider business mailing address

1001 NUT TREE RD STE 110
VACAVILLE CA
95687-4166
US

V. Phone/Fax

Practice location:
  • Phone: 707-455-1343
  • Fax: 707-455-7645
Mailing address:
  • Phone: 707-455-1343
  • Fax: 707-455-7645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA51500
License Number StateCA

VIII. Authorized Official

Name: DR. GAUTAM K VADLAMUDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 707-455-1343