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General NPI Number Information
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NPI Number | 1407633266
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Entity Type | Organization
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Legal Business Name | SATELLITE FOLSOM, LLC
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 210 BLUE RAVINE RD STE 100
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City | FOLSOM
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State | CA
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Zip | 95630-4795
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Country | US
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Telephone | 916-365-8100
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Fax | 916-351-3865
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Provider Business Mailing Address
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Address Line | 5851 LEGACY CIR STE 900
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City | PLANO
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State | TX
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Zip | 75024-5982
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Country | US
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Telephone | 214-736-2663
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN & PRESIDENT
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Name | THOMAS L WEINBERG
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Credential |
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Telephone | 214-736-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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