Healthcare Provider Details

I. General information

NPI: 1336003102
Provider Name (Legal Business Name): PLUMAS LAKE ELEMENTARY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 15TH AVE
SACRAMENTO CA
95822-1502
US

IV. Provider business mailing address

2130 15TH AVE
SACRAMENTO CA
95822-1502
US

V. Phone/Fax

Practice location:
  • Phone: 530-634-9723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JEMMY VANG
Title or Position: SCHOOL PSYCHOLOGIST
Credential: ED.S. M.A.
Phone: 530-634-9723