Healthcare Provider Details

I. General information

NPI: 1427987130
Provider Name (Legal Business Name): STACEY EVENLY CARBAJAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 RESPONSE RD STE 200
SACRAMENTO CA
95815-5255
US

IV. Provider business mailing address

8210 LA ALMENDRA WAY
SACRAMENTO CA
95823-5657
US

V. Phone/Fax

Practice location:
  • Phone: 916-518-3187
  • Fax:
Mailing address:
  • Phone: 916-926-7768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: