Healthcare Provider Details

I. General information

NPI: 1093021008
Provider Name (Legal Business Name): AUDREY ISABELLA ARCHILA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 SIBLEY ST
FOLSOM CA
95630-3222
US

IV. Provider business mailing address

1141 SIBLEY ST
FOLSOM CA
95630-3222
US

V. Phone/Fax

Practice location:
  • Phone: 916-569-8585
  • Fax:
Mailing address:
  • Phone: 916-569-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21120
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number21120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: