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2560 N Texas St Suite C Fairfield CA 94533-1649 | |
| (707) 423-4355 | |
| (707) 423-4353 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2560 N Texas St, Fairfield, California |
| Authorized Official Name and Position | Robert Lawrence Landgraf (PHYSICIAN/OWNER) |
| Authorized Official Contact | 7074234355 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2560 N Texas St Suite C Fairfield CA 94533-1649 Ph: (707) 423-4355 | 2560 N Texas St Suite C Fairfield CA 94533-1649 Ph: (707) 423-4355 |
| NPI Number | 1558704171 |
|---|---|
| Provider Enumeration Date | 04/12/2013 |
| Last Update Date | 04/12/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558704171 | NPI | - | NPPES |
| OOAX70220 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 20A7022 (California) | Primary |
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