Healthcare Provider Details

I. General information

NPI: 1649960113
Provider Name (Legal Business Name): JUDAH GABRIEL SEXTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 09/11/2025
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ALAMEDA DEL PRADO STE 103
NOVATO CA
94949-6698
US

IV. Provider business mailing address

201 ALAMEDA DEL PRADO STE 103
NOVATO CA
94949-6698
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-6966
  • Fax: 415-721-0281
Mailing address:
  • Phone: 415-457-6966
  • Fax: 415-721-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: