Healthcare Provider Details

I. General information

NPI: 1134468796
Provider Name (Legal Business Name): ADRIENNE DIANA HEGR M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3951 PERFORMANCE DR SUITE G
SACRAMENTO CA
95838-3264
US

IV. Provider business mailing address

3951 PERFORMANCE DR SUITE G
SACRAMENTO CA
95838-3264
US

V. Phone/Fax

Practice location:
  • Phone: 916-921-0828
  • Fax:
Mailing address:
  • Phone: 916-921-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number68378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: