Healthcare Provider Details

I. General information

NPI: 1427413772
Provider Name (Legal Business Name): WEST SAC MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 JEFFERSON BLVD SUITE 100
WEST SACRAMENTO CA
95691-5313
US

IV. Provider business mailing address

2455 JEFFERSON BLVD SUITE 100
WEST SACRAMENTO CA
95691-5313
US

V. Phone/Fax

Practice location:
  • Phone: 916-617-2377
  • Fax: 916-680-8065
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ZIAD ALI
Title or Position: OWNER
Credential:
Phone: 916-617-2377