Healthcare Provider Details

I. General information

NPI: 1457172926
Provider Name (Legal Business Name): DANIEL ERHAHON EGHAREVBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7453 RUSH RIVER DR APT 30
SACRAMENTO CA
95831-5250
US

IV. Provider business mailing address

7453 RUSH RIVER DR APT 30
SACRAMENTO CA
95831-5250
US

V. Phone/Fax

Practice location:
  • Phone: 916-280-5631
  • Fax:
Mailing address:
  • Phone: 916-280-5631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN95347754
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN95347754
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95347754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: