Healthcare Provider Details

I. General information

NPI: 1790609402
Provider Name (Legal Business Name): AMINAH IMAN ASBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8889 SPRINGHURST DR
ELK GROVE CA
95624-3215
US

IV. Provider business mailing address

8889 SPRINGHURST DR
ELK GROVE CA
95624-3215
US

V. Phone/Fax

Practice location:
  • Phone: 916-718-0095
  • Fax: 916-897-9525
Mailing address:
  • Phone: 510-220-9272
  • Fax: 916-897-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: