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General NPI Number Information
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NPI Number | 1548989692
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Entity Type | Organization
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Legal Business Name | SACRAMENTO STREET MEDICINE
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 2211 DEL PASO BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95815-3101
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Country | US
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Telephone | 916-720-2237
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Fax | 800-815-8510
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Provider Business Mailing Address
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Address Line | 2917 GRAYSON WAY
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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Country | US
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Telephone | 916-800-4054
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANTHONY MENACHO
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Credential | PA-C
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Telephone | 909-730-5241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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