Healthcare Provider Details

I. General information

NPI: 1629023957
Provider Name (Legal Business Name): ESTHER CERECERES LICENSED VOCATIONAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001A EAST PKWY SUITE 500
SACRAMENTO CA
95823-2501
US

IV. Provider business mailing address

7001A EAST PKWY SUITE 500
SACRAMENTO CA
95823-2501
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-5701
  • Fax:
Mailing address:
  • Phone: 916-875-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN66190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: