Healthcare Provider Details

I. General information

NPI: 1053531392
Provider Name (Legal Business Name): DAVID JAY ALBERTSON R.A.S CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID SAM ALBERTSON MPSS-QFKVXW

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST
GRASS VALLEY CA
95945-5853
US

IV. Provider business mailing address

16198 BROOKS RD
GRASS VALLEY CA
95945-4314
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-2244
  • Fax:
Mailing address:
  • Phone: 530-559-0979
  • Fax: 530-559-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-QFKVXW
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: