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General NPI Number Information
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NPI Number | 1275722746
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Entity Type | Organization
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Legal Business Name | TRAVEL MED INC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 5282 ELVAS AVE
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City | SACRAMENTO
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State | CA
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Zip | 95819-2332
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Country | US
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Telephone | 916-254-2100
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Fax | 916-254-2122
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Provider Business Mailing Address
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Address Line | 5282 ELVAS AVE
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City | SACRAMENTO
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State | CA
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Zip | 95819-2332
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Country | US
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Telephone | 916-254-2100
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Fax | 916-254-2122
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GINA E FLAHARTY
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Credential | NP
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Telephone | 916-254-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 153780
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License Number State | CA
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