Healthcare Provider Details

I. General information

NPI: 1568875136
Provider Name (Legal Business Name): MAGGIE LO OTO RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6403 N POINT WAY
SACRAMENTO CA
95831-1083
US

IV. Provider business mailing address

6403 N POINT WAY
SACRAMENTO CA
95831-1083
US

V. Phone/Fax

Practice location:
  • Phone: 916-217-2450
  • Fax:
Mailing address:
  • Phone: 916-217-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDHAP 406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: