Healthcare Provider Details

I. General information

NPI: 1669024048
Provider Name (Legal Business Name): ERRYNNE REBEKKAH ARCHIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERRYNE REBEKKA LEPLAT ARCHIE

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 SANTA CLARA DR
ROSEVILLE CA
95661-3558
US

IV. Provider business mailing address

1506 BROOK PARK WAY
ROSEVILLE CA
95747-7340
US

V. Phone/Fax

Practice location:
  • Phone: 916-862-5243
  • Fax:
Mailing address:
  • Phone: 916-759-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: