Healthcare Provider Details

I. General information

NPI: 1760973390
Provider Name (Legal Business Name): JILLSBURY SAMSON GRANADOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILLSBURY SAMSON PINEDA

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6833 SPECKLE WAY
SACRAMENTO CA
95842-1838
US

IV. Provider business mailing address

6833 SPECKLE WAY
SACRAMENTO CA
95842-1838
US

V. Phone/Fax

Practice location:
  • Phone: 916-305-5757
  • Fax:
Mailing address:
  • Phone: 916-305-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: