Provider Demographics
NPI:1417231408
Name:SACRAMENTO PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:SACRAMENTO PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SISEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-444-7054
Mailing Address - Street 1:1913 CAPITOL AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-4226
Mailing Address - Country:US
Mailing Address - Phone:916-444-7054
Mailing Address - Fax:916-444-3907
Practice Address - Street 1:1913 CAPITOL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-4226
Practice Address - Country:US
Practice Address - Phone:916-444-7054
Practice Address - Fax:916-444-3907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A93272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty