MEDICARE: DR. GUDDI NIMJE PSYD

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	172V00000X	Community Health Worker	136165	CA
2	171M00000X	Case Manager/Care Coordinator	136165	CA
3	174H00000X	Health Educator	136165	CA
4	101YM0800X	Mental Health Counselor	136165	CA

General Provider Information

NPI Number	:	1235628777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUDDI NIMJE PSYD

Provider Business Mailing Address
First Line	:	429 POWERS DR
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-4438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 POWERS DR
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-4438
Country	:	US
Telephone Number	:	831-264-3853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	03/26/2026

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