MEDICARE: SUTTER BAY MEDICAL FOUNDATION

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	207RI0008X	Hepatology Physician
2	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1679924765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTTER BAY MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	PO BOX 276950
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-6950
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 S MARYLAND PKWY STE 470
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2235
Country	:	US
Telephone Number	:	702-796-9111
Fax Number	:	702-792-9112

Authorized Official
Title or Position	:	SH VP, QUALITY, SAFETY, PATIENT EDU
Name	:	KRISTA LOPES
Credential	:
Telephone Number	:	916-384-7544

Provider Enumeration Date	:	06/29/2016
Last Update Date	:	10/28/2024

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Directions to “SUTTER BAY MEDICAL FOUNDATION ” Practice Location

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