MEDICARE: MY INSURANCE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251X00000X	Supports Brokerage Agency
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1164131702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY INSURANCE SERVICES, INC.

Provider Business Mailing Address
First Line	:	8815 BELLA TERRA PL
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-8850
Country	:	US
Telephone Number	:	916-826-4665
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 CREEKSIDE RIDGE CT STE 215
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-3595
Country	:	US
Telephone Number	:	916-659-0003
Fax Number	:	916-514-5525

Authorized Official
Title or Position	:	PART OWNER
Name	:	YELENA OBUTKOVA
Credential	:
Telephone Number	:	916-826-4665

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	11/25/2024

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