Healthcare Provider Details

I. General information

NPI: 1336551340
Provider Name (Legal Business Name): SACHIKO JEANETTE KAGEYAMA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2014
Last Update Date: 01/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 COYLE AVE
CARMICHAEL CA
95608-0306
US

IV. Provider business mailing address

9480 ALCOSTA WAY
SACRAMENTO CA
95827-1002
US

V. Phone/Fax

Practice location:
  • Phone: 916-537-5000
  • Fax:
Mailing address:
  • Phone: 559-905-5898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001542
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number779035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: