Healthcare Provider Details

I. General information

NPI: 1639641715
Provider Name (Legal Business Name): MR. ROBERT CHARLES FICKETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2018
Last Update Date: 12/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 EUREKA RD
ROSEVILLE CA
95661-3027
US

IV. Provider business mailing address

1600 EUREKA RD
ROSEVILLE CA
95661-3027
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-5428
  • Fax:
Mailing address:
  • Phone: 916-784-5428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number07110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: