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General NPI Number Information
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NPI Number | 1386089878
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Entity Type | Organization
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Legal Business Name | PACIFIC MD HOUSECALLS
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Dates
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Enumeration Date | 05/09/2013
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 2804 GATEWAY OAKS DR SUITE 200
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City | SACRAMENTO
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State | CA
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Zip | 95833-4345
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Country | US
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Telephone | 619-888-7733
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 667
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City | POWAY
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State | CA
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Zip | 92074-0667
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Country | US
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Telephone | 619-888-7733
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Fax | 858-225-6166
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MOMO KUROSAKA
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Credential | M.D.
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Telephone | 619-888-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A062689
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License Number State | CA
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