San Lucas Pediatric Clinic, Inc.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A62749 Issued in CA

Legal business name

SAN LUCAS PEDIATRIC CLINIC, INC.

Practice address

4100 E Commerce Way Ste 100
Sacramento, CA 95834-9501

Phone

(916) 575-9090

Fax

(916) 575-9099

NPI assigned

Apr 12, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Manuel Antonio Arevalo, M.D.NPI 1689694572

Title

President

Phone

(916) 575-9090

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Manuel Antonio Arevalo, MD

  • Pediatrics Physician
  • Sacramento, CA
  • NPI 1689694572
  NPD Authorized official
• Frishta Osmanzada

  • Family Medicine Physician
  • Sacramento, CA
  • NPI 1720632540
  NPD (past)
• Vivian Ching Ruan, CPNP, RN

  • Pediatric Nurse Practitioner
  • Sacramento, CA
  • NPI 1891369526

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769990400000",
    "number": "1073870283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 E COMMERCE WAY STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958349501",
            "telephone_number": "916-575-9090",
            "fax_number": "916-575-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 E COMMERCE WAY STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958349501",
            "telephone_number": "916-575-9090",
            "fax_number": "916-575-9099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7807 Laguna Blvd Ste 440",
            "address_purpose": "LOCATION",
            "city": "Elk Grove",
            "state": "CA",
            "postal_code": "957587953",
            "country_code": "US",
            "telephone_number": "916-575-9090",
            "fax_number": "916-575-9099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAN LUCAS PEDIATRIC CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-12",
        "last_updated": "2026-02-02",
        "certification_date": "2026-02-02",
        "status": "A",
        "authorized_official_last_name": "AREVALO",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "ANTONIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-575-9090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A62749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Lynn Samuelson, MD
• Victor San Cristobal, LVN
• David T. San Felipe
• San Juan Unified School District
• Mieke San Julian, BCBA
• Heather Enid San Miguel, M.D.
• Angela San
• Jonathan R Sanburg, PT
• Valeria Michelle Sanchez Cruz
• Leslie Graciela Sanchez Echeverria

• Pediatrics Physician in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.