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General NPI Number Information
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NPI Number | 1134490493
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Entity Type | Organization
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Legal Business Name | MED 9 CLINIC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 1936 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95816-6638
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Country | US
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Telephone | 916-732-9032
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Fax |
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Provider Business Mailing Address
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Address Line | 1936 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95816-6638
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Country | US
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Telephone | 916-732-9032
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL SCHORR
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Credential | MD
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Telephone | 916-732-9032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C28231
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License Number State | CA
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