Healthcare Provider Details

I. General information

NPI: 1598290801
Provider Name (Legal Business Name): JANNET ARCEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date: 05/21/2020
Reactivation Date: 05/28/2020

III. Provider practice location address

7273 14TH AVE STE 120B
SACRAMENTO CA
95820-3500
US

IV. Provider business mailing address

7273 14TH AVE STE 120B
SACRAMENTO CA
95820-3500
US

V. Phone/Fax

Practice location:
  • Phone: 916-383-6783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number97578
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: