Healthcare Provider Details

I. General information

NPI: 1326439472
Provider Name (Legal Business Name): DYLAN NEWMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 X ST
SACRAMENTO CA
95818-2200
US

IV. Provider business mailing address

1400 X ST
SACRAMENTO CA
95818-2200
US

V. Phone/Fax

Practice location:
  • Phone: 916-738-7400
  • Fax: 916-738-7426
Mailing address:
  • Phone: 916-738-7400
  • Fax: 916-738-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120665
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: