Organization
ROSEVILLE CARDIOLOGY MEDICAL ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID BENNETT WAMPOLD M.D. (PRESIDENT)
(916) 782-2146
Entity
Organization
Contact information
Practice address
2 MEDICAL PLAZA DR, #175, ROSEVILLE, CA 95661-3049
(916) 782-2146
(916) 782-4299
Mailing address
2 MEDICAL PLAZA DR, #175, ROSEVILLE, CA 95661-3049
(916) 782-2146
(916) 782-4299
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A41602
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0094900
—
CA
01
—
ZZZ06970Z
BLUE SHIELD
—
Enumeration date
06/13/2006
Last updated
08/30/2012
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