Provider Demographics
NPI:1679773964
Name:SEBASTIAN CONTI
Entity Type:Organization
Organization Name:SEBASTIAN CONTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-965-5050
Mailing Address - Street 1:6450 COYLE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0305
Mailing Address - Country:US
Mailing Address - Phone:916-965-5050
Mailing Address - Fax:916-965-4040
Practice Address - Street 1:6450 COYLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0305
Practice Address - Country:US
Practice Address - Phone:916-965-5050
Practice Address - Fax:916-965-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG340562086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G340560Medicaid
CAZZZ25872ZMedicare PIN
CAA45772Medicare UPIN