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2230 Stockton Blvd Sacramento CA 95817-1419 | |
| (916) 734-3913 | |
| (916) 734-3384 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 2230 Stockton Blvd, Sacramento, California |
| Authorized Official Name and Position | Cheryl Sadro (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 9167035009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10850 White Rock Rd Rancho Cordova CA 95670-6044 Ph: (916) 734-9200 | 2230 Stockton Blvd Sacramento CA 95817-1419 Ph: (916) 734-3913 |
| NPI Number | 1164415238 |
|---|---|
| Provider Enumeration Date | 08/24/2005 |
| Last Update Date | 08/23/2023 |
| Certification Date | 08/23/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164415238 | NPI | - | NPPES |
| CI4127 | Other | CA | RAILROAD MEDICARE PIN |
| CN4844 | Other | CA | RAILROAD MEDICARE PIN |
| DE7275 | Other | CA | RAILROAD MEDICARE PIN |
| GNP000070 | Medicaid | CA | |
| GPS000040 | Medicaid | CA | |
| ZZZP5701Z | Other | CA | MEDICAID/CHDP PIN |
| CN4400 | Other | CA | RAILROAD MEDICARE PIN |
| DA4168 | Other | CA | RAILROAD MEDICARE PIN |
| GR002104S | Medicaid | CA | |
| CR0028 | Other | CA | RAILROAD MEDICARE PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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