MEDICARE: SACRAMENTO PSYCHIATRIC ASSOCIATES

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	2084P0800X	Psychiatry Physician	20A9327	CA

General Provider Information

NPI Number	:	1417231408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRAMENTO PSYCHIATRIC ASSOCIATES

Provider Business Mailing Address
First Line	:	1913 CAPITOL AVE
Second Line	:	SUITE D
City	:	SACRAMENTO
State	:	CA
Zip	:	95811-4226
Country	:	US
Telephone Number	:	916-444-7054
Fax Number	:	916-444-3907

Provider Business Practice Location Address
First Line	:	1913 CAPITOL AVE
Second Line	:	SUITE D
City	:	SACRAMENTO
State	:	CA
Zip	:	95811-4226
Country	:	US
Telephone Number	:	916-444-7054
Fax Number	:	916-444-3907

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. DAVID SISEMORE
Credential	:	D.O.
Telephone Number	:	916-444-7054

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	10/07/2011

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