Provider Demographics
NPI:1689628844
Name:PRIMARY CARE FAMILY MEDICAL CLINIC INC.
Entity Type:Organization
Organization Name:PRIMARY CARE FAMILY MEDICAL CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:916-689-2121
Mailing Address - Street 1:7501 HOSPITAL DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5405
Mailing Address - Country:US
Mailing Address - Phone:916-689-2121
Mailing Address - Fax:916-689-2198
Practice Address - Street 1:7501 HOSPITAL DR
Practice Address - Street 2:SUITE 205
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5405
Practice Address - Country:US
Practice Address - Phone:916-689-2121
Practice Address - Fax:916-689-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP34722261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care