1972825255 NPI number — DOCTORS' COMPREHENSIVE MEDICAL GROUP

Table of content: (NPI 1972825255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972825255 NPI number — DOCTORS' COMPREHENSIVE MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS' COMPREHENSIVE MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972825255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
813 HARBOR BLVD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
WEST SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95691-2201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-682-1088
Provider Business Mailing Address Fax Number:
559-746-0369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9045 BRUCEVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95758-5948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-682-1088
Provider Business Practice Location Address Fax Number:
559-746-0369
Provider Enumeration Date:
02/26/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BIJAK
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
505-270-3823

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)