Healthcare Provider Details

I. General information

NPI: 1265629588
Provider Name (Legal Business Name): MS. BOBBI J KIZZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001A EAST PKWY
SACRAMENTO CA
95823-2501
US

IV. Provider business mailing address

7001A EAST PKWY
SACRAMENTO CA
95823-2501
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number403670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: