Healthcare Provider Details

I. General information

NPI: 1518128685
Provider Name (Legal Business Name): RONALD DEMETRUIS SHEAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2008
Last Update Date: 06/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 EL CAMINO AVE
CARMICHAEL CA
95608-4650
US

IV. Provider business mailing address

377 BELL AVE
SACRAMENTO CA
95838-2162
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-5122
  • Fax: 916-609-5161
Mailing address:
  • Phone: 916-437-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: