Provider Demographics
NPI:1629037841
Name:FOGATA, MARIA LUISA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
Last Name:FOGATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:SUITE 3100 ACC
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-3606
Mailing Address - Fax:916-734-8490
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 3100 ACC
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-3606
Practice Address - Fax:916-734-8490
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA816912085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A816910Medicare ID - Type Unspecified