ELICA HEALTH CENTERS- HARBOR MEDICAL CENTER (NPI# 1457872517) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457872517 |
| Entity Type | Organization |
| Organization Name | ELICA HEALTH CENTERS- HARBOR MEDICAL CENTER |
| Other Organization Name | ELICA HEALTH CENTERS- HARBOR MEDICAL CENTER |
| Practice Address |
804 Harbor Blvd West Sacramento CA 95691 |
| Mailing Address |
1860 Howe Ave Ste 440 Sacramento CA 95825-1098 |
| Practice Telephone | 8553542242 |
| Practice Fax Number | 9164572667 |
| Mailing Telephone | 9165698484 |
| Mailing Fax Number | 9165505003 |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2018-06-07 |
| Authorized Official Name | TATYANA BAK (CEO) |
| Authorized Official Telephone | 9165698484 |
| Is Organization Subpart | Y |
| Parent Organization Name | ELICA HEALTH CENTERS |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208D00000X | General Practice | 550000706 | CA | Allopathic & Osteopathic Physicians |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
550000706 | CA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Elica Health Centers- Harbor Medical Center | Other Name - Individual/Organization |
| Street Address |
804 HARBOR BLVD |
| City | WEST SACRAMENTO |
| State | CA |
| Zip Code | 95691 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477537413 | Vladimir Rafanov | Psychiatry & Neurology | 804 Harbor Blvd, West Sacramento, CA 95691-2202 | 2005-12-02 |
| 1376056531 | Daria Gregory | Family Medicine | 804 Harbor Blvd, West Sacramento, CA 95691-2202 | 2017-11-09 |
| 1003966037 | Valerie Druzhnikov | Physician Assistant | 804 Harbor Blvd, West Sacramento, CA 95691-2202 | 2007-01-11 |
| 1932284650 | Olga Kashlinskaya | Pediatrics | 804 Harbor Blvd, West Sacramento, CA 95691-2202 | 2006-10-25 |
| 1942392170 | Arnold Greenberg Md Inc | Family Medicine | 804 Harbor Blvd, West Sacramento, CA 95691 | 2006-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386298545 | Breanna Lenae Garcia | Registered Nurse | 980 Central Street, Apartment 312, West Sacramento, CA 95691 | 2019-07-26 |
| 1093192650 | Heliodoro Magana | Physician Assistant | 2901 Colleent Court, West Sacramento, CA 95691 | 2015-05-04 |
| 1699187823 | Eugene Louis | Pharmacist | 1601 1/2 West Capital Ave., West Sacramento, CA 95691 | 2014-05-22 |
| 1184874026 | Dental Corporation of Amardeep Gill Dds | Dentist | 2455 Jefferson Blvd, Suite 130, West Sacramento, CA 95691 | 2008-09-29 |
| 1487784328 | Sidney Bahr Freeman | Dentist | 820 Westacre Rd, West Sacramento, CA 95691 | 2007-03-07 |
| 1073671038 | Tari Leanne Tribble | Physician Assistant | 2101 Stone Blvd #190, West Sacramento, CA 95691 | 2006-12-04 |
| 1942375068 | Yuly Vilderman Dds A Dental Corporation | Dentist | 825 Harbor Blvd, West Sacramento, CA 95691 | 2006-11-22 |
| 1760569537 | Elizabeth Barber | Marriage & Family Therapist | 1250 Harbor Blvd #600, Telecare Yolo Strides, West Sacramento, CA 95691 | 2006-11-01 |
| 1831207059 | Norman Gary Larsen | Physical Therapist | 3680 Industrial Blvd, #550h Us Health Works Med Group, West Sacramento, CA 95691 | 2006-08-28 |
| 1093790305 | Nancy Warden | Pediatrics | 1276 Halyard Dr, West Sacramento, CA 95691 | 2005-12-08 |
| Find all providers in zip 95691 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144687955 | Communicare Health Centers | Clinic/Center | 3680 Industrial Blvd Ste 100, West Sacramento, CA 95691-6504 | 2016-01-25 |
| 1548425853 | Elica Health Centers | Clinic/Center | 155 15th St Ste A, West Sacramento, CA 95691-3737 | 2008-07-25 |
| 1942332754 | Communicare Health Centers | Clinic/Center | 500b Jefferson Blvd # 195, West Sacramento, CA 95605-2349 | 2007-03-09 |
| 1710087515 | Communicare Health Centers | Clinic/Center | 500 B Jefferson Blvd, #180, West Sacramento, CA 95605 | 2006-09-22 |
| 1366068553 | Elica Health Centers | Clinic/Center | 1276 Halyard Dr, West Sacramento, CA 95691-3412 | 2020-06-23 |
| 1760013494 | Elica Health Centers | Clinic/Center | 1276 Halyard Dr, West Sacramento, CA 95691-3412 | 2020-01-31 |
| 1295293330 | Wellspace Health | Clinic/Center | 2727 W Capitol Ave, West Sacramento, CA 95691-2220 | 2019-03-07 |
| 1205341336 | Elica Health Centers | Clinic/Center | 1276 Halyard Dr, West Sacramento, CA 95691-3412 | 2017-12-12 |
| 1730693805 | Elica Health Centers | Clinic/Center | 1276 Halyard Dr, West Sacramento, CA 95691-3412 | 2017-11-27 |
| 1215155031 | Communicare Health Centers | Clinic/Center | 500 Jefferson Blvd Ste B180, West Sacramento, CA 95605-2394 | 2007-04-24 |
| Find all providers in WEST SACRAMENTO | ||||
| City | WEST SACRAMENTO |
| Zip Code | 95691 |
Please comment or provide details below to improve the information on ELICA HEALTH CENTERS- HARBOR MEDICAL CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.