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General NPI Number Information
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NPI Number | 1689628844
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE FAMILY MEDICAL CLINIC INC.
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7501 HOSPITAL DR SUITE 205
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City | SACRAMENTO
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State | CA
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Zip | 95823-5405
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Country | US
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Telephone | 916-689-2121
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Fax | 916-689-2198
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Provider Business Mailing Address
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Address Line | 7501 HOSPITAL DR SUITE 205
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City | SACRAMENTO
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State | CA
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Zip | 95823-5405
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Country | US
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Telephone | 916-689-2121
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Fax | 916-689-2198
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Authorized Official
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Title or Position | MANAGER
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Name | DERRICK JOHN MULLIN
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Credential | FNP
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Telephone | 916-689-2121
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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 | FNP34722
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License Number State | CA
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