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SAN LUCAS PEDIATRIC INC. NPI 1073870283


NPI Information

NPI: 1073870283
Provider Name: SAN LUCAS PEDIATRIC, INC.
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 05D2081468

Address:
4100 E COMMERCE WAY STE 100
SACRAMENTO, CA
ZIP 95834
Phone: (916) 575-9090
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SAN LUCAS PEDIATRIC, INC. is a pediatrics in Sacramento, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. SAN LUCAS PEDIATRIC, INC. NPI is 1073870283. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4100 E COMMERCE WAY STE 100
SACRAMENTO, CA
ZIP 95834-501
Phone: (916) 575-9090
Fax: (916) 575-9099

The provider's authorized official is Manuel A. Arevalo .
The authorized official title is Medical Director and has the following contact phone number (916) 575-9090.

The CLIA number assigned to this NPI record is 05D2081468 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/12/2012 and was last updated on 4/12/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsA62749CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
14346437MEDICARE PINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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