Organization
LT PROACTIVE CARE CLINIC CALIFORNIA, PA
Active
Other names
LT Proactive Care Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAMBIZ FARBAKHSH M.D. (OWNER/MEDICAL DIRECTOR)
(952) 541-7157
Entity
Organization
Contact information
Practice address
1435 EAST ROSEVILLE PKWY, ROSEVILLE, CA 95661
(916) 472-2057
(916) 472-2058
Mailing address
1435 EAST ROSEVILLE PKWY, ROSEVILLE, CA 95661
(916) 472-2057
(916) 472-2058
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/25/2015
Last updated
09/25/2015
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