Healthcare Provider Details

I. General information

NPI: 1134008824
Provider Name (Legal Business Name): HAVEN OBGYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CREEKSIDE DR STE 3100
FOLSOM CA
95630-3486
US

IV. Provider business mailing address

6091 EDGEHILL DR
EL DORADO HILLS CA
95762-5475
US

V. Phone/Fax

Practice location:
  • Phone: 916-269-8865
  • Fax: 916-265-9659
Mailing address:
  • Phone: 916-269-8865
  • Fax: 916-265-9659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NIKITA MISHRA
Title or Position: MD OWNER
Credential: MD
Phone: 916-269-8865