Provider Demographics
NPI:1659195766
Name:FOLSOM CITY MD
Entity type:Organization
Organization Name:FOLSOM CITY MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANMUGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-300-6554
Mailing Address - Street 1:407 SERPA WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6316
Mailing Address - Country:US
Mailing Address - Phone:646-275-9999
Mailing Address - Fax:
Practice Address - Street 1:1600 CREEKSIDE DR STE 3200
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3447
Practice Address - Country:US
Practice Address - Phone:916-252-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty