Healthcare Provider Details

I. General information

NPI: 1841011665
Provider Name (Legal Business Name): AMITA PRASAD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 BRUCEVILLE RD
SACRAMENTO CA
95823
US

IV. Provider business mailing address

8009 BRUCEVILLE RD
SACRAMENTO CA
95823-2332
US

V. Phone/Fax

Practice location:
  • Phone: 916-288-0326
  • Fax:
Mailing address:
  • Phone: 916-288-0326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number692147
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95369447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: