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SAN LUCAS PEDIATRIC CLINIC, INC.
NPI 1073870283
Pediatrics in Sacramento, CA

Active since April 12, 2012CLIA 05D1062720 · Waiver
4100 E COMMERCE WAY STE 100, SACRAMENTO, CA 95834(916) 575-9090(916) 575-9099 Get Directions Write a Review

NPPES record last updated: February 2, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About San Lucas Pediatric Clinic, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAN LUCAS PEDIATRIC CLINIC, INC. (NPI 1073870283) is a healthcare organization registered as a pediatrics in Sacramento, California and active in the NPI registry since April 2012. The organization holds a CLIA Waiver certificate valid through December 20, 2026, maintains a secondary practice location in Elk Grove, and lists Manuel Antonio Arevalo, President, as its authorized official.

NPPES Registry Identity

NPI1073870283
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameSAN LUCAS PEDIATRIC CLINIC, INC.
Location Address4100 E COMMERCE WAY STE 100Sacramento, CA 95834-9501
Mailing Address4100 E Commerce Way Ste 100Sacramento, CA 95834-9501 · (916) 575-9090 · Fax (916) 575-9099
Phone(916) 575-9090
Fax(916) 575-9099
Organization SubpartNo
Authorized OfficialManuel Antonio ArevaloPresident · (916) 575-9090
Enumeration DateApril 12, 2012
Last NPPES UpdateFebruary 2, 2026
NPPES CertifiedFebruary 2, 2026
✔ NPI 1073870283 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in CA · A62749
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
4100 E COMMERCE WAY STE 100, Sacramento, CA 95834
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Secondary Practice Location 1

Location 17807 Laguna Blvd Ste 440Elk Grove, CA 95758-7953 · Phone (916) 575-9090 · Fax (916) 575-9099

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D1062720

San Lucas Pediatric Clinic, Inc · Sacramento, CA
Active · expires Dec 20, 2026
CLIA Number05D1062720
Laboratory TypePhysician Office
Certificate Effective DateDecember 21, 2024
Certificate Expiration DateDecember 20, 2026
Laboratory DirectorManuel A. Arevalo
Laboratory Phone(916) 575-9090
Laboratory LocationSan Lucas Pediatric Clinic, Inc4100 East Commerce Way Ste 100, Sacramento, CA 95834
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2081468

San Lucas Pediatric Clinic, Inc · Elk Grove, CA
Expired · Jul 24, 2026
CLIA Number05D2081468
Laboratory TypePhysician Office
Certificate Effective DateJuly 25, 2024
Certificate Expiration DateJuly 24, 2026
Laboratory DirectorManuel A. Arevalo, MD
Laboratory Phone(916) 575-9090
Laboratory LocationSan Lucas Pediatric Clinic, Inc7807 Laguna Blvd Ste 440, Elk Grove, CA 95758
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FRISHTA OSMANZADA
Family Medicine
4100 E COMMERCE WAY STE 100
SACRAMENTO, CA 95834
Sacramento County (916) 575-9090
VIVIAN CHING RUAN CPNP, RN
Nurse Practitioner (Pediatrics)
4100 E COMMERCE WAY STE 100
SACRAMENTO, CA 95834
Sacramento County (916) 575-9090

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is San Lucas Pediatric Clinic, Inc.'s NPI number?

The NPI number for San Lucas Pediatric Clinic, Inc. is 1073870283. It was assigned to this organization in the NPPES registry on April 12, 2012.

Where is San Lucas Pediatric Clinic, Inc. located?

San Lucas Pediatric Clinic, Inc. is located at 4100 E Commerce Way Ste 100, Sacramento, CA 95834. The listed phone number is (916) 575-9090.

What is San Lucas Pediatric Clinic, Inc.'s specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does San Lucas Pediatric Clinic, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D1062720) is associated with this NPI, valid through December 20, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for San Lucas Pediatric Clinic, Inc. was last updated on February 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.