Provider Demographics
NPI:1326583030
Name:SACRAMENTO VALLEY PEDIATRICS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SACRAMENTO VALLEY PEDIATRICS MEDICAL GROUP INC
Other - Org Name:PEDIATRIC MEDICAL CENTER OF SACRAMENTO
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PERLA-INEZ
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAULINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-681-1130
Mailing Address - Street 1:7501 HOSPITAL DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7501 HOSPITAL DR
Practice Address - Street 2:SUITE 203
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5405
Practice Address - Country:US
Practice Address - Phone:916-681-1130
Practice Address - Fax:916-681-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005332363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty