# SACRAMENTO STREET MEDICINE

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

## Provider details

- **NPI number:** 1548989692
- **Authorized official:** ANTHONY MENACHO PA-C (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (909) 730-5241

## Contact information

- **Practice address:** 2211 DEL PASO BLVD, SACRAMENTO, CA 95815-3101
- **Practice address phone:** (916) 720-2237
- **Practice address fax:** (800) 815-8510
- **Mailing address:** 2917 GRAYSON WAY, RANCHO CORDOVA, CA 95670
- **Mailing address phone:** (916) 800-4054

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | — |
| 171M00000X | Case Manager/Care Coordinator | — | — | — |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | NULL | — |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | — | — |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | NULL | Yes |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/23/2022
- **Last updated:** 12/17/2024