Healthcare Provider Details

I. General information

NPI: 1275564809
Provider Name (Legal Business Name): SANDRA ANN KAYL LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 RESEARCH DR
SACRAMENTO CA
95838
US

IV. Provider business mailing address

7750 ANTELOPE RD
CITRUS HEIGHTS CA
95610
US

V. Phone/Fax

Practice location:
  • Phone: 916-648-0980
  • Fax: 916-874-1950
Mailing address:
  • Phone: 916-728-1451
  • Fax: 916-728-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberVN139588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: