Healthcare Provider Details

I. General information

NPI: 1497667869
Provider Name (Legal Business Name): DOMINIQUE SADIE MATTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 WALNUT AVE
CARMICHAEL CA
95608-2191
US

IV. Provider business mailing address

1059 EVELYN LN
SACRAMENTO CA
95864-7724
US

V. Phone/Fax

Practice location:
  • Phone: 916-974-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: