Healthcare Provider Details

I. General information

NPI: 1083951651
Provider Name (Legal Business Name): GITA SESHADRI PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 W EL CAMINO AVE STE 200
SACRAMENTO CA
95833-1867
US

IV. Provider business mailing address

PO BOX 13498
SACRAMENTO CA
95813-3498
US

V. Phone/Fax

Practice location:
  • Phone: 949-294-1704
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 48254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: