Healthcare Provider Details

I. General information

NPI: 1609133602
Provider Name (Legal Business Name): BETHANY CERTA SASAKI NP, CNM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 19TH ST
SACRAMENTO CA
95811-6745
US

IV. Provider business mailing address

2025 P ST
SACRAMENTO CA
95811-5213
US

V. Phone/Fax

Practice location:
  • Phone: 916-936-2229
  • Fax:
Mailing address:
  • Phone: 916-936-2229
  • Fax: 916-307-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number650391
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number235738
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP95005739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: