Healthcare Provider Details

I. General information

NPI: 1285411553
Provider Name (Legal Business Name): PADMAJA DEKIVADIA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 MARCONI AVE
SACRAMENTO CA
95821-5303
US

IV. Provider business mailing address

3737 MARCONI AVE
SACRAMENTO CA
95821-5303
US

V. Phone/Fax

Practice location:
  • Phone: 916-485-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95217844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: