Provider Demographics
NPI:1629191267
Name:CAPITAL ALLERGY AND RESPIRATORY DISEASE CENTER A MED CORP
Entity type:Organization
Organization Name:CAPITAL ALLERGY AND RESPIRATORY DISEASE CENTER A MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-233-2613
Mailing Address - Street 1:1451 SECRET RAVINE PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:916-453-8696
Mailing Address - Fax:916-453-8715
Practice Address - Street 1:5609 J STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:916-453-8696
Practice Address - Fax:916-453-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A734080Medicare PIN
CA00C386400Medicare PIN
CA00A961720Medicare PIN
CAZZZ03529ZMedicare PIN