Basic Information
| Provider Information | |||||||||
| NPI: | 1255309803 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | G S S C LTD PARTNERSHIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2288 AUBURN BLVD | ||||||||
| Address2: | #201 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958211618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169297229 | ||||||||
| FaxNumber: | 9169292590 | ||||||||
| Practice Location | |||||||||
| Address1: | 2288 AUBURN BLVD | ||||||||
| Address2: | #201 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958211618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169297229 | ||||||||
| FaxNumber: | 9169292590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 02/01/2017 | ||||||||
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| AuthorizedOfficialLastName: | BRUNONE | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9169297229 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 26030000116 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | ZZR11465H | 05 | CA | MEDICAID |