1104591296 NPI number — CAPITOL RAPID CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104591296 NPI number — CAPITOL RAPID CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITOL RAPID CARE
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:
1104591296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4617 FREEPORT BLVD STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95822-2015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-731-7384
Provider Business Mailing Address Fax Number:
916-422-2127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4617 FREEPORT BLVD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95822-2015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-731-7384
Provider Business Practice Location Address Fax Number:
916-422-2127
Provider Enumeration Date:
08/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
DELGADILLO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
QUINCY
Authorized Official Title or Position:
PRESIDENT/MEDICAL DIRECTOR
Authorized Official Telephone Number:
916-730-0527

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1902842354 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982099263 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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