Healthcare Provider Details

I. General information

NPI: 1245193283
Provider Name (Legal Business Name): AMY TITO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 6TH ST
SACRAMENTO CA
95811-0396
US

IV. Provider business mailing address

500 N 6TH ST
SACRAMENTO CA
95811-0396
US

V. Phone/Fax

Practice location:
  • Phone: 279-258-2850
  • Fax:
Mailing address:
  • Phone: 279-258-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number744779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: