1508899758 NPI number — CAPITOL INTERNAL MEDICINE ASSOCIATES

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 1508899758 NPI number — CAPITOL INTERNAL MEDICINE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITOL INTERNAL MEDICINE ASSOCIATES
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:
CAPITOL INTERNAL MEDICINE ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1508899758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6620 COYLE AVE STE 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMICHAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95608-6337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-966-8500
Provider Business Mailing Address Fax Number:
916-966-8555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6620 COYLE AVE STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMICHAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95608-6337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-512-3963
Provider Business Practice Location Address Fax Number:
916-966-8555
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAMRA
Authorized Official First Name:
DHEERAJ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
916-966-8500

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A89808 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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