Provider Demographics
NPI:1578845657
Name:SACRAMENTO ULTRASOUND, INC.
Entity Type:Organization
Organization Name:SACRAMENTO ULTRASOUND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIAGNOSTIC MEDICAL SONOGRAPHER
Authorized Official - Prefix:MS
Authorized Official - First Name:SIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DERMISHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-752-7750
Mailing Address - Street 1:2233 WATT AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-0509
Mailing Address - Country:US
Mailing Address - Phone:916-752-7750
Mailing Address - Fax:916-487-4032
Practice Address - Street 1:2233 WATT AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0509
Practice Address - Country:US
Practice Address - Phone:916-752-7750
Practice Address - Fax:916-487-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHT 102230261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology