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General NPI Number Information
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NPI Number | 1235565300
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Entity Type | Organization
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Legal Business Name | MEDTEN MEDICAL GROUP INC
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Dates
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Enumeration Date | 09/20/2013
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 5767 GREENBACK LN SUITE 200
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City | SACRAMENTO
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State | CA
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Zip | 95841-2013
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Country | US
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Telephone | 916-220-6487
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Fax |
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Provider Business Mailing Address
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Address Line | 3221 RAPALLO PL
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-5463
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Country | US
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Telephone | 916-220-6487
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. NAVEEN MANOHAR
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Credential | M.D
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Telephone | 916-220-6487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | A88977
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License Number State | CA
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