Basic Information
| Provider Information | |||||||||
| NPI: | 1558347138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOGO | ||||||||
| FirstName: | ALBINA | ||||||||
| MiddleName: | SALAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 ENTRADA RD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958645314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164890362 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2261 DOUGLAS BLVD | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956613831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167837109 | ||||||||
| FaxNumber: | 9167733405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 11/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G48957 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 00G489570 | 05 | CA | MEDICAID |