Healthcare Provider Details

I. General information

NPI: 1760762983
Provider Name (Legal Business Name): NATHAN ANDREW TRUEBLOOD PHD, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 COYLE AVE
CARMICHAEL CA
95608-0306
US

IV. Provider business mailing address

3300 DOUGLAS BLVD SUITE 405
ROSEVILLE CA
95661-3844
US

V. Phone/Fax

Practice location:
  • Phone: 916-537-5210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number21742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: