Provider Demographics
NPI:1932270394
Name:COUNTY OF SACRAMENTO
Entity Type:Organization
Organization Name:COUNTY OF SACRAMENTO
Other - Org Name:IMMUNIZATION ASSISTANCE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-875-6086
Mailing Address - Street 1:7001A EAST PKWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2501
Mailing Address - Country:US
Mailing Address - Phone:916-875-5881
Mailing Address - Fax:916-875-5888
Practice Address - Street 1:7001A EAST PKWY
Practice Address - Street 2:SUITE 600
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2501
Practice Address - Country:US
Practice Address - Phone:916-875-7468
Practice Address - Fax:916-875-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45398251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ94651ZMedicare ID - Type UnspecifiedIMMUNIZATION PROGRAM