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General NPI Number Information
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NPI Number | 1992988513
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Entity Type | Organization
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Legal Business Name | SA HAGGERTY, INC., A MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 5290 ELVAS AVE
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City | SACRAMENTO
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State | CA
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Zip | 95819-2332
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Country | US
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Telephone | 916-739-1507
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Fax |
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Provider Business Mailing Address
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Address Line | 1416 TOWSE DR
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City | WOODLAND
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State | CA
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Zip | 95776-6715
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Country | US
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Telephone | 707-365-7640
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Fax | 815-361-9113
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Authorized Official
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Title or Position | CEO
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Name | DR. SHERYL ANN HAGGERTY
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Credential | M.D.
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Telephone | 707-365-7640
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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 | A98050
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License Number State | CA
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