| |
7911 Laguna Blvd Elk Grove CA 95758-7920 | |
(916) 733-5801 | |
(916) 683-0232 |
Full Name | |
---|---|
Speciality | Clinic/center - Multi-specialty |
Location | 7911 Laguna Blvd, Elk Grove, California |
Authorized Official Name and Position | Theresa M Hylen (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 9168512559 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 60000 File #72938 San Francisco CA 94160-2938 Ph: (916) 733-3397 | 7911 Laguna Blvd Elk Grove CA 95758-7920 Ph: (916) 733-5801 |
NPI Number | 1558495937 |
---|---|
Provider Enumeration Date | 03/15/2007 |
Last Update Date | 11/18/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558495937 | NPI | - | NPPES |
0019838 | Other | CIGNA | |
KYZ | Other | BLUE CROSS | |
341996544 | Other | SPECIAL PURPOSE TAX ID # | |
ZZZ09972Z | Other | BLUE SHIELD | |
983 | Other | HEALTH NET | |
195 | Other | HEALTH NET | |
GR006356B | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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