Provider Demographics
NPI:1275705832
Name:SACRAMENTO DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:SACRAMENTO DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:W
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-353-2270
Mailing Address - Street 1:3195 FOLSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5202
Mailing Address - Country:US
Mailing Address - Phone:916-353-2270
Mailing Address - Fax:916-353-2279
Practice Address - Street 1:3195 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5202
Practice Address - Country:US
Practice Address - Phone:916-353-2270
Practice Address - Fax:916-353-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53496174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty