Individual
SALLY A. SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3841 N FREEWAY BLVD STE 210, SACRAMENTO, CA 95834-1948
(916) 925-7010
Mailing address
658 BIANCO COURT, DAVIS, CA 95616
(916) 925-7010
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
G85941
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000810342662
PHCS
CA
01
—
082689
HEALTH NET
CA
01
—
1327116
UNITED HEALTHCARE
CA
01
—
1741911
FIRST HEALTH
CA
01
—
1851073
GREAT WEST
CA
01
—
3273994
CIGNA
CA
01
—
4594534
AETNA
CA
01
—
46355
INTERPLAN
CA
01
—
90118919
PACIFICARE
CA
01
—
G85941
BLUE CROSS
CA
01
—
MCMG171600
WESTERN HEALTH ADVANTAGE
CA
Enumeration date
10/04/2006
Last updated
05/17/2016
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