=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982240321
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED CARE FOUNDATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2019
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1765 CHALLENGE WAY STE 130
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95815-5098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-905-5363
-----------------------------------------------------
Fax | 916-877-7963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1765 CHALLENGE WAY STE 130
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95815-5098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-905-5363
-----------------------------------------------------
Fax | 916-877-7963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SIMA DERMISHYAN
-----------------------------------------------------
Credential | RDMS
-----------------------------------------------------
Telephone | 916-752-7750
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------