Provider Demographics
NPI:1952081606
Name:SNJ CAPITOL CORPORATION
Entity Type:Organization
Organization Name:SNJ CAPITOL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJIWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOPARAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-379-6186
Mailing Address - Street 1:9764 CANERIA WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6225
Mailing Address - Country:US
Mailing Address - Phone:630-379-6186
Mailing Address - Fax:
Practice Address - Street 1:9764 CANERIA WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6225
Practice Address - Country:US
Practice Address - Phone:630-379-6186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA119799OtherSTATE LICENSE