Healthcare Provider Details

I. General information

NPI: 1508758939
Provider Name (Legal Business Name): EVELYN JEPNGETICH SAGASI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 LESLIE LN
CERES CA
95307-2326
US

IV. Provider business mailing address

PO BOX 490
CERES CA
95307-0490
US

V. Phone/Fax

Practice location:
  • Phone: 209-531-2088
  • Fax:
Mailing address:
  • Phone: 209-531-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: