MEDICARE: MALTIQUE, LLC

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1962046482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALTIQUE, LLC

Provider Business Mailing Address
First Line	:	4700 ELVAS AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-2250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 ELVAS AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-2250
Country	:	US
Telephone Number	:	916-454-4700
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JACK SANOFSKY
Credential	:
Telephone Number	:	916-454-4700

Provider Enumeration Date	:	10/29/2019
Last Update Date	:	01/10/2020

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Directions to “MALTIQUE, LLC ” Practice Location

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