Healthcare Provider Details

I. General information

NPI: 1669394466
Provider Name (Legal Business Name): ROGELIO LOWE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5834 VALLEY SPRINGS WAY
ELK GROVE CA
95758-5316
US

IV. Provider business mailing address

5834 VALLEY SPRINGS WAY
ELK GROVE CA
95758-5316
US

V. Phone/Fax

Practice location:
  • Phone: 510-200-8957
  • Fax:
Mailing address:
  • Phone: 510-200-8957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: