Healthcare Provider Details

I. General information

NPI: 1730448366
Provider Name (Legal Business Name): ASHLEY HARTT ANDERSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY ERIN HARTT DO

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 W COVELL BLVD
DAVIS CA
95616-5658
US

IV. Provider business mailing address

3400 DATA DR ATTN: CREDENTIALING/PAYER ENROLLMENT
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 530-668-2600
  • Fax: 530-756-5917
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A16535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: