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4441 Auburn Blvd Suite E Sacramento CA 95841-4139 | |
| (916) 473-5764 | |
| (916) 473-5766 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 4441 Auburn Blvd, Sacramento, California |
| Authorized Official Name and Position | A. Jonathan Porteus (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9165505444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
777 12th Street Suite 250 Sacramento CA 95814 Ph: (916) 550-5444 | 4441 Auburn Blvd Suite E Sacramento CA 95841-4139 Ph: (916) 473-5764 |
| NPI Number | 1033295084 |
|---|---|
| Provider Enumeration Date | 10/31/2006 |
| Last Update Date | 02/25/2020 |
| Certification Date | 02/25/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033295084 | NPI | - | NPPES |
| 343405000 | Medicaid | CA |
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