MEDICARE: ALLERGY MEDICAL GROUP OF THE NORTH AREA INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A305380	OTHER	CA	NONE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083612980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY MEDICAL GROUP OF THE NORTH AREA INC.

Provider Business Mailing Address
First Line	:	935 RESERVE DR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-1340
Country	:	US
Telephone Number	:	916-782-7758
Fax Number	:	916-782-7770

Provider Business Practice Location Address
First Line	:	935 RESERVE DR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-1340
Country	:	US
Telephone Number	:	916-782-7758
Fax Number	:	916-782-7770

Authorized Official
Title or Position	:	CEO OWNER
Name	:	SUNIL PUSHPAKUMARA PERERA
Credential	:	MD
Telephone Number	:	916-782-7758

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/05/2018

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