Provider Demographics
NPI:1528198512
Name:CAREMAX OF SACRAMENTO, FBA, INC
Entity Type:Organization
Organization Name:CAREMAX OF SACRAMENTO, FBA, INC
Other - Org Name:CAREMAX NORCAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANDRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-622-2092
Mailing Address - Street 1:1716 MELANZANE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3986
Mailing Address - Country:US
Mailing Address - Phone:916-789-7391
Mailing Address - Fax:
Practice Address - Street 1:7641 GALILEE ROAD
Practice Address - Street 2:SUITE # 150
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678
Practice Address - Country:US
Practice Address - Phone:916-788-9788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA033454332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies