Provider Demographics
NPI:1578660692
Name:LABRIOLA, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LABRIOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63458207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000810354347OtherPHCS
CA768487OtherUNITED HEALTHCARE
CAMCMG385600OtherWESTERN HEALTH ADVANTAGE
CA1072765OtherFIRST HEALTH
CA10807OtherINTERPLAN
CA5707274OtherFIRST HEALTH
CA009456OtherHEALTH NET
CA4509033OtherAETNA
CA90026126OtherPACIFICARE
CAG63458OtherBLUE CROSS
CA1089901OtherGREAT WEST
CA3277645OtherCIGNA
CAG63458OtherBLUE CROSS
CA1072765OtherFIRST HEALTH