| As Above | |
|
6808 Rio Tejo Way Elk Grove CA 95757-3432 | |
| (916) 875-0802 | |
| (916) 875-0854 |
| Full Name | As Above |
|---|---|
| Speciality | Clinic/center |
| Location | 6808 Rio Tejo Way, Elk Grove, California |
| Authorized Official Name and Position | Estelita D. Avera (LVN) |
| Authorized Official Contact | 9168750802 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| As Above 6808 Rio Tejo Way Elk Grove CA 95757-3432 Ph: (916) 875-0802 | As Above 6808 Rio Tejo Way Elk Grove CA 95757-3432 Ph: (916) 875-0802 |
| NPI Number | 1467558783 |
|---|---|
| Provider Enumeration Date | 09/15/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467558783 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | VN111149 (California) | Primary |
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