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8110 Laguna Blvd Elk Grove CA 95758-7904 | |
| (916) 683-3950 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 8110 Laguna Blvd, Elk Grove, California |
| Authorized Official Name and Position | Allen D Hall (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9167348203 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4900 Broadway Ste 1200 Sacramento CA 95820-1532 Ph: (916) 734-9654 | 8110 Laguna Blvd Elk Grove CA 95758-7904 Ph: (916) 683-3950 |
| NPI Number | 1083694616 |
|---|---|
| Provider Enumeration Date | 01/19/2006 |
| Last Update Date | 10/09/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083694616 | NPI | - | NPPES |
| GR0063732 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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