Provider Demographics
NPI:1316790025
Name:SUTTER ROSEVILLE MEDICAL CENTER
Entity type:Organization
Organization Name:SUTTER ROSEVILLE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GESLANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:909-708-9408
Mailing Address - Street 1:1 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3037
Mailing Address - Country:US
Mailing Address - Phone:916-316-5189
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3037
Practice Address - Country:US
Practice Address - Phone:916-781-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty