Provider Demographics
NPI:1710414933
Name:CREATIVE CLINICAL RESEARCH, INC.
Entity type:Organization
Organization Name:CREATIVE CLINICAL RESEARCH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:916-513-7027
Mailing Address - Street 1:7807 LAGUNA BLVD STE 480
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7953
Mailing Address - Country:US
Mailing Address - Phone:916-513-7027
Mailing Address - Fax:916-895-2184
Practice Address - Street 1:930 ALHAMBRA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4433
Practice Address - Country:US
Practice Address - Phone:916-385-4438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962848374Medicaid
CA1124313093Medicaid
CA1689712317Medicaid