Provider Demographics
NPI:1649471798
Name:PRENATAL DIAGNOSIS OF NORTHERN CALIFORNIA MEDICAL GROUP INC.
Entity type:Organization
Organization Name:PRENATAL DIAGNOSIS OF NORTHERN CALIFORNIA MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-736-6888
Mailing Address - Street 1:1111 EXPOSITION BLVD.
Mailing Address - Street 2:BLDG. 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4324
Mailing Address - Country:US
Mailing Address - Phone:916-736-6888
Mailing Address - Fax:916-779-3260
Practice Address - Street 1:1111 EXPOSITION BLVD.
Practice Address - Street 2:BLDG. 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4324
Practice Address - Country:US
Practice Address - Phone:916-736-6888
Practice Address - Fax:916-779-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF10469291U00000X
CA189620174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G189620Medicaid
CA00G189620Medicaid