| Green Haven Family Practice, Inc | |
|
1102 Corporate Way Ste 170 Sacramento CA 95831-3895 | |
| (916) 661-5336 | |
| (916) 382-4630 |
| Full Name | Green Haven Family Practice, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1102 Corporate Way, Sacramento, California |
| Authorized Official Name and Position | Scarlett Tan Lu (OWNER) |
| Authorized Official Contact | 9166615336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Haven Family Practice, Inc 1102 Corporate Way Ste 170 Sacramento CA 95831-3895 Ph: (916) 661-5336 | Green Haven Family Practice, Inc 1102 Corporate Way Ste 170 Sacramento CA 95831-3895 Ph: (916) 661-5336 |
| NPI Number | 1093137788 |
|---|---|
| Provider Enumeration Date | 01/14/2014 |
| Last Update Date | 07/16/2014 |
| Medicare PECOS PAC ID | 0749502813 |
|---|---|
| Medicare Enrollment ID | O20141126000743 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093137788 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A8387 (California) | Primary |
| Provider Name | Scarlett T Lu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548373491 PECOS PAC ID: 5991727695 Enrollment ID: I20051221001071 |
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