Healthcare Provider Details

I. General information

NPI: 1003975749
Provider Name (Legal Business Name): ALCIRA REVELO SAHAMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PLACER ST
REDDING CA
96001-1170
US

IV. Provider business mailing address

PO BOX 22501
BAKERSFIELD CA
93390-2501
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-5818
  • Fax: 530-245-9927
Mailing address:
  • Phone: 530-246-5818
  • Fax: 530-245-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA86015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: