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General NPI Number Information
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NPI Number | 1073870283
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Entity Type | Organization
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Legal Business Name | SAN LUCAS PEDIATRIC CLINIC, INC.
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 4100 E COMMERCE WAY STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95834-9501
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Country | US
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Telephone | 916-575-9090
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Fax | 916-575-9099
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Provider Business Mailing Address
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Address Line | 4100 E COMMERCE WAY STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95834-9501
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Country | US
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Telephone | 916-575-9090
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Fax | 916-575-9099
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANUEL ANTONIO AREVALO
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Credential | M.D.
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Telephone | 916-575-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A62749
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License Number State | CA
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