Healthcare Provider Details

I. General information

NPI: 1760152656
Provider Name (Legal Business Name): JEWELENA RENE ECHEAGARAY RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 CORPORATE WAY STE 1
SACRAMENTO CA
95831-6119
US

IV. Provider business mailing address

7550 RUSH RIVER DR APT 43
SACRAMENTO CA
95831-4939
US

V. Phone/Fax

Practice location:
  • Phone: 916-424-1703
  • Fax:
Mailing address:
  • Phone: 559-210-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH37145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: