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General NPI Number Information
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NPI Number | 1962647529
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Entity Type | Organization
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Legal Business Name | SACRAMENTO FAMILY MEDICAL CLINIC
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 9717 ELK GROVE FLORIN RD STE A
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City | ELK GROVE
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State | CA
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Zip | 95624-2262
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Country | US
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Telephone | 916-714-7400
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Fax | 916-714-7410
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Provider Business Mailing Address
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Address Line | 9717 ELK GROVE FLORIN RD STE A
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City | ELK GROVE
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State | CA
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Zip | 95624-2262
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Country | US
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Telephone | 916-714-7400
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Fax | 916-714-7410
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Authorized Official
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Title or Position | OWNER
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Name | DR. GILBERT SIMON
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Credential | M.D
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Telephone | 916-563-7230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 10-00008104
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License Number State | CA
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