Healthcare Provider Details

I. General information

NPI: 1407772247
Provider Name (Legal Business Name): MS. SAVANNAH LAYNE HULLIN KEITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 PLAZA DR
ROCKLIN CA
95765-4404
US

IV. Provider business mailing address

3466 DATA DR APT 414
RANCHO CORDOVA CA
95670-7959
US

V. Phone/Fax

Practice location:
  • Phone: 916-580-1103
  • Fax: 916-749-4520
Mailing address:
  • Phone: 209-637-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: