Healthcare Provider Details

I. General information

NPI: 1073497400
Provider Name (Legal Business Name): ASHLEY BURCIAGA EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 13TH ST
SACRAMENTO CA
95831-1801
US

IV. Provider business mailing address

PO BOX 22944
SACRAMENTO CA
95822-0944
US

V. Phone/Fax

Practice location:
  • Phone: 415-845-0119
  • Fax:
Mailing address:
  • Phone: 916-500-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4706
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number4706
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: