Healthcare Provider Details

I. General information

NPI: 1942952411
Provider Name (Legal Business Name): ELAINE JANE NAGGI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N LINCOLN ST STE A
DIXON CA
95620-3238
US

IV. Provider business mailing address

1024 FOX HOUND RD
VACAVILLE CA
95687-7517
US

V. Phone/Fax

Practice location:
  • Phone: 707-366-5246
  • Fax: 707-676-5087
Mailing address:
  • Phone: 707-322-8209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: