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General NPI Number Information
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NPI Number | 1639062870
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Entity Type | Organization
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Legal Business Name | RIVER PEDIATRICS CLINIC
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 3535 65TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95820-2057
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Country | US
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Telephone | 530-564-8439
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Fax |
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Provider Business Mailing Address
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Address Line | 3707 ORANGERIE WAY
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City | CARMICHAEL
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State | CA
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Zip | 95608-2845
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Country | US
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Telephone | 520-444-2504
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DOUGLAS GROSS
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Credential | MD
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Telephone | 530-219-8960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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