Provider Demographics
NPI:1962647529
Name:SACRAMENTO FAMILY MEDICAL CLINIC
Entity Type:Organization
Organization Name:SACRAMENTO FAMILY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-563-7230
Mailing Address - Street 1:9717 ELK GROVE FLORIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2262
Mailing Address - Country:US
Mailing Address - Phone:916-714-7400
Mailing Address - Fax:916-714-7410
Practice Address - Street 1:9717 ELK GROVE FLORIN RD STE A
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2262
Practice Address - Country:US
Practice Address - Phone:916-714-7400
Practice Address - Fax:916-714-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10-00008104208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty