Healthcare Provider Details

I. General information

NPI: 1447691720
Provider Name (Legal Business Name): MRS. AMBER LYNN LONGHITANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

IV. Provider business mailing address

1570 BRIAR LN
LINCOLN CA
95648-3012
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7251
  • Fax:
Mailing address:
  • Phone: 530-575-2686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: