Provider Demographics
NPI:1144385915
Name:GREATER SACRAMENTO PEDIATRICS ASSOC INC
Entity Type:Organization
Organization Name:GREATER SACRAMENTO PEDIATRICS ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:K
Authorized Official - Last Name:ARAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-965-4612
Mailing Address - Street 1:6555 COYLE AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0302
Mailing Address - Country:US
Mailing Address - Phone:916-965-4612
Mailing Address - Fax:916-965-9384
Practice Address - Street 1:6555 COYLE AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-965-4612
Practice Address - Fax:916-965-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA421302080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID NUMBER