Healthcare Provider Details

I. General information

NPI: 1720509714
Provider Name (Legal Business Name): NEIL KHUSHAL CADCIII
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 22ND ST
SACRAMENTO CA
95816-3503
US

IV. Provider business mailing address

500 22ND ST
SACRAMENTO CA
95816-3503
US

V. Phone/Fax

Practice location:
  • Phone: 209-748-2470
  • Fax: 209-748-5861
Mailing address:
  • Phone: 209-748-2470
  • Fax: 209-748-5861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberB001450521
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW127468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: