Provider Demographics
NPI:1568792711
Name:TLC CONCIERGE MEDICAL CENTRE
Entity Type:Organization
Organization Name:TLC CONCIERGE MEDICAL CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-987-5360
Mailing Address - Street 1:6611 FOLSOM AUBURN RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2102
Mailing Address - Country:US
Mailing Address - Phone:916-987-5360
Mailing Address - Fax:916-988-8826
Practice Address - Street 1:6611 FOLSOM AUBURN RD
Practice Address - Street 2:SUITE F
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2102
Practice Address - Country:US
Practice Address - Phone:916-987-5360
Practice Address - Fax:916-988-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67792261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care