Provider Demographics
NPI:1760570600
Name:PEDIATRIC MEDICAL ASSOCIATES OF SACRAMENTO INC
Entity Type:Organization
Organization Name:PEDIATRIC MEDICAL ASSOCIATES OF SACRAMENTO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-866-8786
Mailing Address - Street 1:650 HOWE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4732
Mailing Address - Country:US
Mailing Address - Phone:916-924-9337
Mailing Address - Fax:916-924-8281
Practice Address - Street 1:650 HOWE AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0000
Practice Address - Country:US
Practice Address - Phone:916-924-9337
Practice Address - Fax:916-924-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty