Healthcare Provider Details

I. General information

NPI: 1598674350
Provider Name (Legal Business Name): NORTH CAL NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9198 GREENBACK LN
ORANGEVALE CA
95662-5900
US

IV. Provider business mailing address

117 ELKHORN BLVD
RIO LINDA CA
95673-3214
US

V. Phone/Fax

Practice location:
  • Phone: 916-544-1256
  • Fax:
Mailing address:
  • Phone: 916-544-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: TYNESHA ZACARIAS
Title or Position: OWNER
Credential:
Phone: 916-544-1256