Healthcare Provider Details

I. General information

NPI: 1659719599
Provider Name (Legal Business Name): CATHLEEN ENCARNACION PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 COYLE AVENUE
CARMICHAEL CA
95608
US

IV. Provider business mailing address

3400 DATA DR PHYSICIAN SUPPORT SERVICES
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-536-2585
  • Fax: 916-536-2583
Mailing address:
  • Phone: 916-379-2948
  • Fax: 916-858-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: