Basic Information
| Provider Information | |||||||||
| NPI: | 1275705832 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SACRAMENTO DIAGNOSTICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3195 FOLSOM BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163532270 | ||||||||
| FaxNumber: | 9163532279 | ||||||||
| Practice Location | |||||||||
| Address1: | 3195 FOLSOM BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163532270 | ||||||||
| FaxNumber: | 9163532279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2008 | ||||||||
| LastUpdateDate: | 03/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | ARMSTRONG | ||||||||
| AuthorizedOfficialFirstName: | RANDALL | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | MBR | ||||||||
| AuthorizedOfficialTelephone: | 9163532270 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | G53496 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.