Healthcare Provider Details

I. General information

NPI: 1902975980
Provider Name (Legal Business Name): VENUS ROSE GRAY RADI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 AUBURN BLVD # 2200
SACRAMENTO CA
95841-4167
US

IV. Provider business mailing address

4330 AUBURN BLVD # 2200
SACRAMENTO CA
95841-4167
US

V. Phone/Fax

Practice location:
  • Phone: 916-473-5764
  • Fax: 916-473-5766
Mailing address:
  • Phone: 916-473-5764
  • Fax: 916-473-5766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: