Healthcare Provider Details

I. General information

NPI: 1245799238
Provider Name (Legal Business Name): NANCY GAMROTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10390 COLOMA RD STE 4
RANCHO CORDOVA CA
95670-2152
US

IV. Provider business mailing address

PO BOX 278781
SACRAMENTO CA
95827-8781
US

V. Phone/Fax

Practice location:
  • Phone: 916-742-2775
  • Fax:
Mailing address:
  • Phone: 916-662-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: