Healthcare Provider Details

I. General information

NPI: 1811915556
Provider Name (Legal Business Name): MEENA WALIA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BROADWAY PRIMARY CARE CLINIC
SACRAMENTO CA
95820
US

IV. Provider business mailing address

9354 LOST SPRINGS CT
ELK GROVE CA
95624
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-2554
  • Fax: 916-874-9297
Mailing address:
  • Phone: 916-686-5516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN173013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: