Provider Demographics
NPI:1730293309
Name:SACRAMENTO HEART & VASCULAR
Entity Type:Organization
Organization Name:SACRAMENTO HEART & VASCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-830-2046
Mailing Address - Street 1:1111 KENNEDY PL STE 1
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1266
Mailing Address - Country:US
Mailing Address - Phone:530-757-1999
Mailing Address - Fax:
Practice Address - Street 1:1111 KENNEDY PL STE 1
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1266
Practice Address - Country:US
Practice Address - Phone:530-757-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ39823ZMedicare ID - Type Unspecified