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General NPI Number Information
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NPI Number | 1235150400
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Entity Type | Organization
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Legal Business Name | CAPITOL NEPHROLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 333 UNIVERSITY AVE STE 120
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City | SACRAMENTO
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State | CA
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Zip | 95825-6532
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Country | US
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Telephone | 916-929-8564
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Fax | 916-929-4529
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Provider Business Mailing Address
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Address Line | 1111 EXPOSITION BLVD STE 300
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City | SACRAMENTO
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State | CA
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Zip | 95815-4324
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Country | US
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Telephone | 916-929-8564
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Fax | 916-929-4529
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Authorized Official
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Title or Position | ACCOUNTS MANAGER
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Name | MRS. CHRISTINA M TANI
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Credential |
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Telephone | 916-426-1949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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