MEDICARE: FOLSOM CITY MD

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1659195766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOLSOM CITY MD

Provider Business Mailing Address
First Line	:	407 SERPA WAY
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-6316
Country	:	US
Telephone Number	:	646-275-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 CREEKSIDE DR STE 3200
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3447
Country	:	US
Telephone Number	:	916-252-5000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MALATHI SHANMUGAM
Credential	:	MD
Telephone Number	:	212-300-6554

Provider Enumeration Date	:	11/14/2024
Last Update Date	:	01/08/2025

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Directions to “FOLSOM CITY MD ” Practice Location

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