Healthcare Provider Details

I. General information

NPI: 1922910009
Provider Name (Legal Business Name): JAKE PAXTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TWIN RIVERS SCHOOL DISTRICT 5115 DUDLEY BOULEVARD
MCCLELLAN PARK CA
95652
US

IV. Provider business mailing address

4556 BRAND WAY
SACRAMENTO CA
95819-2235
US

V. Phone/Fax

Practice location:
  • Phone: 916-879-7690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: