Provider Demographics
NPI:1801143102
Name:QUALITY MEDICAL-ROSEVILLE, PC
Entity type:Organization
Organization Name:QUALITY MEDICAL-ROSEVILLE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-784-1050
Mailing Address - Street 1:729 SUNRISE AVE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4565
Mailing Address - Country:US
Mailing Address - Phone:916-784-1050
Mailing Address - Fax:916-784-1989
Practice Address - Street 1:729 SUNRISE AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4565
Practice Address - Country:US
Practice Address - Phone:916-784-1050
Practice Address - Fax:916-784-1989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty