# BOOMER MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538458351
- **Authorized official:** DR. KIMBERLY LE M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (916) 480-0707

## Contact information

- **Practice address:** 3525 WATT AVE, SACRAMENTO, CA 95821
- **Practice address phone:** (916) 480-0707
- **Mailing address:** PO BOX 1939, CARMICHAEL, CA 95609-1939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | A46083 | CA | — |
| 2081P0004X | Spinal Cord Injury Medicine Physician | G72879 | CA | Yes |

## Other

- **Enumeration date:** 04/01/2011
- **Last updated:** 02/20/2012