Healthcare Provider Details

I. General information

NPI: 1790605004
Provider Name (Legal Business Name): DAVID MICLEA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8445 OLD AUBURN RD
CITRUS HEIGHTS CA
95610-0817
US

IV. Provider business mailing address

8445 OLD AUBURN RD
CITRUS HEIGHTS CA
95610-0817
US

V. Phone/Fax

Practice location:
  • Phone: 916-242-0907
  • Fax:
Mailing address:
  • Phone: 916-242-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number347005371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: