Healthcare Provider Details

I. General information

NPI: 1740159359
Provider Name (Legal Business Name): ESTELLE N EFOMBO FOUSSAT KYANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 03/01/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 WATT AVE
SACRAMENTO CA
95821-2667
US

IV. Provider business mailing address

3550 WATT AVE
SACRAMENTO CA
95821-2667
US

V. Phone/Fax

Practice location:
  • Phone: 916-228-9606
  • Fax: 916-229-8493
Mailing address:
  • Phone: 916-228-9606
  • Fax: 916-229-8493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: