Healthcare Provider Details

I. General information

NPI: 1275728537
Provider Name (Legal Business Name): MRS. LUPE PESSOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9510 ELK GROVE FLORIN RD
ELK GROVE CA
95624-1801
US

IV. Provider business mailing address

9510 ELK GROVE FLORIN RD
ELK GROVE CA
95624-1801
US

V. Phone/Fax

Practice location:
  • Phone: 916-686-7568
  • Fax: 916-689-7596
Mailing address:
  • Phone: 916-686-7568
  • Fax: 916-689-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: