Provider Demographics
NPI:1528196565
Name:GREATER SACRAMENTO PEDIATRICS ASSOC INC
Entity Type:Organization
Organization Name:GREATER SACRAMENTO PEDIATRICS ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-965-4612
Mailing Address - Street 1:6555 COYLE AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0302
Mailing Address - Country:US
Mailing Address - Phone:916-788-3030
Mailing Address - Fax:916-788-0171
Practice Address - Street 1:1301 SECRET RAVINE PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3102
Practice Address - Country:US
Practice Address - Phone:916-788-3030
Practice Address - Fax:916-788-0171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER SACRAMENTO PEDIATRICS ASSOC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID NUMBER