Provider Demographics
NPI:1811001472
Name:SACRAMENTO HEART & VASCUALER
Entity Type:Organization
Organization Name:SACRAMENTO HEART & VASCUALER
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 1:8120 TIMBERLAKE WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5414
Mailing Address - Country:US
Mailing Address - Phone:916-688-1600
Mailing Address - Fax:
Practice Address - Street 1:8120 TIMBERLAKE WAY STE 207
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5414
Practice Address - Country:US
Practice Address - Phone:916-688-1600
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
CAZZZ16172ZMedicare ID - Type Unspecified