Provider Demographics
NPI:1366761496
Name:DEFELICE, NATHANIEL RICHARD (MD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:RICHARD
Last Name:DEFELICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1300 ETHAN WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2296
Mailing Address - Country:US
Mailing Address - Phone:916-679-3513
Mailing Address - Fax:916-679-3563
Practice Address - Street 1:1508 ALHAMBRA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6510
Practice Address - Country:US
Practice Address - Phone:916-679-3590
Practice Address - Fax:916-482-3647
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA129005207R00000X
CAA129005207RI0200X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease