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General NPI Number Information
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NPI Number | 1568792711
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Entity Type | Organization
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Legal Business Name | TLC CONCIERGE MEDICAL CENTRE
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 08/28/2010
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Provider Practice Location Address
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Address Line | 6611 FOLSOM AUBURN RD SUITE F
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City | FOLSOM
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State | CA
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Zip | 95630-2102
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Country | US
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Telephone | 916-987-5360
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Fax | 916-988-8826
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Provider Business Mailing Address
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Address Line | 6611 FOLSOM AUBURN RD SUITE F
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City | FOLSOM
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State | CA
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Zip | 95630-2102
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Country | US
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Telephone | 916-987-5360
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Fax | 916-988-8826
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOHN T BAKOS
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Credential | M.D.
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Telephone | 916-987-5360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A67792
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License Number State | CA
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