Provider Demographics
NPI: | 1144593310 |
---|---|
Name: | OBSTETRIX MEDICAL GROUP OF SACRAMENTO, P.C. |
Entity Type: | Organization |
Organization Name: | OBSTETRIX MEDICAL GROUP OF SACRAMENTO, P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ASSISTANT SECRETARY |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | SANTANA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 800-243-3839 |
Mailing Address - Street 1: | 1301 CONCORD TER |
Mailing Address - Street 2: | |
Mailing Address - City: | SUNRISE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33323-2843 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-243-3839 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5301 F ST |
Practice Address - Street 2: | SUITE 207 |
Practice Address - City: | ORANGE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95819 |
Practice Address - Country: | US |
Practice Address - Phone: | 916-733-7111 |
Practice Address - Fax: | 916-733-7110 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-02-17 |
Last Update Date: | 2023-10-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |