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General NPI Number Information
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NPI Number | 1962502195
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Entity Type | Organization
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Legal Business Name | SACRAMENTO PEDIATRIC ENDOCRINE AND DIABETES MEDICAL CLINIC INC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5301 F ST SUITE 209
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City | SACRAMENTO
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State | CA
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Zip | 95819-3226
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Country | US
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Telephone | 916-733-6006
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Fax | 916-454-1446
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Provider Business Mailing Address
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Address Line | 5301 F ST SUITE 209
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City | SACRAMENTO
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State | CA
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Zip | 95819-3226
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Country | US
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Telephone | 916-733-6006
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Fax | 916-454-1446
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Authorized Official
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Title or Position | OWNER
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Name | MR. BAGHER M SHEIKHOLISLAM
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Credential | MD
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Telephone | 916-733-6006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A23623
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License Number State | CA
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