Healthcare Provider Details

I. General information

NPI: 1124943436
Provider Name (Legal Business Name): CALLIE MASUHARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9461 SOARING OAKS DR
ELK GROVE CA
95758-1075
US

IV. Provider business mailing address

2862 CONDOR ST
WEST SACRAMENTO CA
95691-6120
US

V. Phone/Fax

Practice location:
  • Phone: 916-683-3073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: