Provider Demographics
NPI:1548409378
Name:COMMUNITY NEONATOLOGY OF SACRAMENTO MEDICAL GROUP
Entity Type:Organization
Organization Name:COMMUNITY NEONATOLOGY OF SACRAMENTO MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-492-3514
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92674-1359
Mailing Address - Country:US
Mailing Address - Phone:949-492-3514
Mailing Address - Fax:949-366-2390
Practice Address - Street 1:6501 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0306
Practice Address - Country:US
Practice Address - Phone:916-537-5135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31661372080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty