Healthcare Provider Details

I. General information

NPI: 1568622637
Provider Name (Legal Business Name): DANA EMIL GROVES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 L ST
SACRAMENTO CA
95816-5616
US

IV. Provider business mailing address

1402 SHERIDAN AVE
ROSEVILLE CA
95661-5723
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-3003
  • Fax:
Mailing address:
  • Phone: 916-781-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number664921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: