Healthcare Provider Details

I. General information

NPI: 1467558783
Provider Name (Legal Business Name): SACRAMENTO COUNTY DHHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6808 RIO TEJO WAY
ELK GROVE CA
95757-3432
US

IV. Provider business mailing address

6808 RIO TEJO WAY
ELK GROVE CA
95757-3432
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-0802
  • Fax: 916-875-0854
Mailing address:
  • Phone: 916-875-0802
  • Fax: 916-875-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberVN111149
License Number StateCA

VIII. Authorized Official

Name: MRS. ESTELITA D. AVERA
Title or Position: LVN
Credential:
Phone: 916-875-0802