Organization
CHILDREN'S MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID L. BANNISTER M.D. (OWNER)
(916) 786-5800
Entity
Organization
Contact information
Practice address
729 SUNRISE AVE, SUITE 501, ROSEVILLE, CA 95661-4565
(916) 786-5800
(916) 773-3001
Mailing address
729 SUNRISE AVE, SUITE 501, ROSEVILLE, CA 95661-4565
(916) 786-5800
(916) 773-3001
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G031541
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A44802
—
CA
Enumeration date
12/10/2006
Last updated
08/22/2020
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