Healthcare Provider Details

I. General information

NPI: 1679874465
Provider Name (Legal Business Name): FAHM SAELEE FLORENDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7806 UPLANDS WAY STE A
CITRUS HEIGHTS CA
95610-7567
US

IV. Provider business mailing address

7806 UPLANDS WAY STE A
CITRUS HEIGHTS CA
95610-7567
US

V. Phone/Fax

Practice location:
  • Phone: 916-967-6253
  • Fax: 916-967-9413
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number29734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: