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1804 19th St Suite 100 Sacramento CA 95811 | |
| (916) 246-0889 | |
| (916) 458-8468 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1804 19th St, Sacramento, California |
| Authorized Official Name and Position | Sergio Vicuna (OWNER) |
| Authorized Official Contact | 9162460889 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
17000 Red Hill Ave Irvine CA 92614-5626 Ph: (714) 845-8890 | 1804 19th St Suite 100 Sacramento CA 95811 Ph: (916) 246-0889 |
| NPI Number | 1275089963 |
|---|---|
| Provider Enumeration Date | 09/01/2016 |
| Last Update Date | 09/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275089963 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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