Organization
ALLERGY MEDICAL GROUP OF THE NORTH AREA INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUNIL PUSHPAKUMARA PERERA MD (CEO OWNER)
(916) 782-7758
Entity
Organization
Contact information
Practice address
935 RESERVE DR, ROSEVILLE, CA 95678-1340
(916) 782-7758
(916) 782-7770
Mailing address
935 RESERVE DR, ROSEVILLE, CA 95678-1340
(916) 782-7758
(916) 782-7770
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A305380
NONE
CA
05
—
ZZZ76738Z
—
CA
Enumeration date
07/13/2005
Last updated
04/05/2018
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