Basic Information
Provider Information
NPI: 1083997449
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RINALDI
FirstName: PETER
MiddleName: DOMINIC
NamePrefix:  
NameSuffix: JR.
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4860 Y ST
Address2: SUITE 3800
City: SACRAMENTO
State: CA
PostalCode: 958172307
CountryCode: US
TelephoneNumber: 9167345885
FaxNumber: 9167347904
Practice Location
Address1: 4860 Y ST
Address2: SUITE 3800
City: SACRAMENTO
State: CA
PostalCode: 958172307
CountryCode: US
TelephoneNumber: 9167345885
FaxNumber: 9167347904
Other Information
ProviderEnumerationDate: 09/22/2011
LastUpdateDate: 04/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XX0005X20A10766CAY Allopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine

No ID Information.


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