Healthcare Provider Details

I. General information

NPI: 1659265494
Provider Name (Legal Business Name): JARED ALEXANDER BROKLOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7017 SUNBURST WAY
CITRUS HEIGHTS CA
95621-3521
US

IV. Provider business mailing address

7017 SUNBURST WAY
CITRUS HEIGHTS CA
95621-3521
US

V. Phone/Fax

Practice location:
  • Phone: 916-548-0874
  • Fax:
Mailing address:
  • Phone: 916-548-0874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number749309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: