Provider Demographics
NPI:1396817474
Name:MAJETICH, NICK JR (MD)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:MAJETICH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DRIVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-564-3040
Mailing Address - Fax:916-564-3065
Practice Address - Street 1:6401 COYLE AVE
Practice Address - Street 2:STE 416
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608
Practice Address - Country:US
Practice Address - Phone:916-966-3501
Practice Address - Fax:916-966-2805
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62359207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G623590Medicaid
CAZZZ47675ZOtherBLUE SHIELD
CAZZZ54665ZOtherBLUE SHIELD
CAGR0068235Medicaid
CAZZZ62306ZOtherBLUE SHIELD
CAGR0068230Medicaid
CAGR0068232Medicaid
CAGR006823BMedicaid
CA060034401OtherRAILROAD MEDICARE
CAGR0068231Medicaid
CAZZZ47673ZOtherBLUE SHIELD
CAZZZ47676ZOtherBLUE SHIELD
CA00G623590Medicaid
CAZZZ00967ZMedicare PIN
CAGR0068231Medicaid
CAZZZ00966ZMedicare PIN
CAZZZ17828ZMedicare PIN
CAZZZ47676ZOtherBLUE SHIELD
CA060034401OtherRAILROAD MEDICARE
CAGR0068235Medicaid