Healthcare Provider Details

I. General information

NPI: 1851553887
Provider Name (Legal Business Name): JACQUELINE ALICE JOHNSEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SUTTER PL
DAVIS CA
95616-6201
US

IV. Provider business mailing address

2016 BIDWELL WAY
SACRAMENTO CA
95818-4308
US

V. Phone/Fax

Practice location:
  • Phone: 530-757-5111
  • Fax:
Mailing address:
  • Phone: 562-394-8133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A12181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: