Healthcare Provider Details

I. General information

NPI: 1992578678
Provider Name (Legal Business Name): SAMUEL ISAIAS PENATE VASQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001A EAST PKWY STE 100
SACRAMENTO CA
95823-2501
US

IV. Provider business mailing address

7001A EAST PKWY STE 100
SACRAMENTO CA
95823-2501
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-5471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC20443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: