Basic Information
| Provider Information | |||||||||
| NPI: | 1912270281 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIX CARDIOLOGY OF SACRAMENTO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 CONCORD TER | ||||||||
| Address2: | |||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543840175 | ||||||||
| FaxNumber: | 9548580434 | ||||||||
| Practice Location | |||||||||
| Address1: | 5609 J ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958193957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004636628 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2012 | ||||||||
| LastUpdateDate: | 02/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | TWIGGS | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGIONAL PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8002433839 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
No ID Information.