Provider Demographics
NPI:1063209237
Name:SHIREE FATCH MEDICAL CORPORATION
Entity type:Organization
Organization Name:SHIREE FATCH MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIREE
Authorized Official - Middle Name:SEGEV
Authorized Official - Last Name:FATCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-783-0580
Mailing Address - Street 1:1650 LEAD HILL BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 LEAD HILL BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3072
Practice Address - Country:US
Practice Address - Phone:916-783-0580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty