Provider Demographics
NPI:1558404624
Name:ARCA, MICHAEL DERRICK (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DERRICK
Last Name:ARCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:ARCA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:501 J ST
Mailing Address - Street 2:SUITE #230
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-2325
Mailing Address - Country:US
Mailing Address - Phone:916-205-8185
Mailing Address - Fax:
Practice Address - Street 1:501 J ST
Practice Address - Street 2:SUITE #230
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2325
Practice Address - Country:US
Practice Address - Phone:916-205-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAL19216Medicare UPIN