Healthcare Provider Details

I. General information

NPI: 1477475465
Provider Name (Legal Business Name): VAN BURTON CA ASW 113376
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 HOBBS LN
SACRAMENTO CA
95842-1642
US

IV. Provider business mailing address

5825 HOBBS LN
SACRAMENTO CA
95842-1642
US

V. Phone/Fax

Practice location:
  • Phone: 916-283-8280
  • Fax: 916-283-8259
Mailing address:
  • Phone: 916-283-8280
  • Fax: 916-283-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: