| Sac City Md | |
|
8120 Timberlake Way Ste 108 Sacramento CA 95823-5413 | |
| (916) 252-5000 | |
| (916) 245-3252 |
| Full Name | Sac City Md |
|---|---|
| Speciality | Family Medicine |
| Location | 8120 Timberlake Way Ste 108, Sacramento, California |
| Authorized Official Name and Position | Malathi Shanmugam (PRESIDENT) |
| Authorized Official Contact | 9162525000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sac City Md 8120 Timberlake Way Ste 108 Sacramento CA 95823-5413 Ph: (916) 252-5000 | Sac City Md 8120 Timberlake Way Ste 108 Sacramento CA 95823-5413 Ph: (916) 252-5000 |
| NPI Number | 1679180939 |
|---|---|
| Provider Enumeration Date | 09/29/2020 |
| Last Update Date | 04/06/2021 |
| Medicare PECOS PAC ID | 2365852118 |
|---|---|
| Medicare Enrollment ID | O20210322000198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679180939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Devonne Ortiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376846527 PECOS PAC ID: 9931378585 Enrollment ID: I20110816000444 |
| Provider Name | Malathi Shanmugam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356509608 PECOS PAC ID: 9032259478 Enrollment ID: I20160628001828 |
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