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General NPI Number Information
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NPI Number | 1659195766
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Entity Type | Organization
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Legal Business Name | FOLSOM CITY MD
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 1600 CREEKSIDE DR STE 3200
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City | FOLSOM
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State | CA
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Zip | 95630-3447
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Country | US
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Telephone | 916-252-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 407 SERPA WAY
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City | FOLSOM
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State | CA
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Zip | 95630-6316
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Country | US
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Telephone | 646-275-9999
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MALATHI SHANMUGAM
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Credential | MD
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Telephone | 212-300-6554
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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 |
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License Number State |
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