Provider Demographics
NPI:1558347138
Name:GOGO, ALBINA SALAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBINA
Middle Name:SALAS
Last Name:GOGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:920 ENTRADA RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5314
Mailing Address - Country:US
Mailing Address - Phone:916-489-0362
Mailing Address - Fax:
Practice Address - Street 1:2261 DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3831
Practice Address - Country:US
Practice Address - Phone:916-783-7109
Practice Address - Fax:916-773-3405
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48957208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G489570Medicaid
CAA51223Medicare UPIN