Healthcare Provider Details

I. General information

NPI: 1629995758
Provider Name (Legal Business Name): JEREMY CHARLES LEMERT CMPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9705 PARKTREE WAY
ELK GROVE CA
95624-2622
US

IV. Provider business mailing address

9705 PARKTREE WAY
ELK GROVE CA
95624-2622
US

V. Phone/Fax

Practice location:
  • Phone: 916-685-4296
  • Fax:
Mailing address:
  • Phone:
  • Fax: 916-685-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-PBAEOC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: