Organization
BOOMER MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLY LE M.D. (MEDICAL DIRECTOR)
(916) 480-0707
Entity
Organization
Contact information
Practice address
3525 WATT AVE, SACRAMENTO, CA 95821
(916) 480-0707
Mailing address
PO BOX 1939, CARMICHAEL, CA 95609-1939
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
A46083
CA
2081P0004X
Spinal Cord Injury Medicine Physician
Primary
G72879
CA
Other
Enumeration date
04/01/2011
Last updated
02/20/2012
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