Healthcare Provider Details

I. General information

NPI: 1770973786
Provider Name (Legal Business Name): JOHN MUEGGENBURG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 SPRING VALLEY DR
ROSEVILLE CA
95661-7329
US

IV. Provider business mailing address

1406 SPRING VALLEY DR
ROSEVILLE CA
95661-7329
US

V. Phone/Fax

Practice location:
  • Phone: 916-300-4902
  • Fax:
Mailing address:
  • Phone: 916-300-4902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT 1052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: