Organization
WEST SACRAMENTOPEDIATRIC MEDICAL GROUP,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JUDITH J TARRANT RN,FNP (PROVIDER, CO-OWNER)
(916) 371-3787
Entity
Organization
Contact information
Practice address
1050 JEFFERSON BLVD, WEST SACRAMENTO, CA 95691-3304
(916) 371-3787
(916) 371-3790
Mailing address
1050 JEFFERSON BLVD, WEST SACRAMENTO, CA 95691-3304
(916) 371-3787
(916) 371-3790
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
208000000X
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841836
PIN
CA
01
—
GR0101570
GROUP NUMBER FOR CHDP
CA
Enumeration date
11/14/2006
Last updated
09/17/2008
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