Healthcare Provider Details

I. General information

NPI: 1467053272
Provider Name (Legal Business Name): WEST SACRAMENTO PRIMARY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 JEFFERSON BLVD STE 100
WEST SACRAMENTO CA
95691-5329
US

IV. Provider business mailing address

2455 JEFFERSON BLVD STE 100
WEST SACRAMENTO CA
95691-5329
US

V. Phone/Fax

Practice location:
  • Phone: 916-617-2377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ZIAD ALI
Title or Position: OWNER
Credential: MD
Phone: 209-334-5719