Healthcare Provider Details

I. General information

NPI: 1053190637
Provider Name (Legal Business Name): GRACE NJOROGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 GARFIELD AVE
SACRAMENTO CA
95841-2009
US

IV. Provider business mailing address

1085 SANDRINGHAM WAY
ROSEVILLE CA
95661-5321
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-7800
  • Fax:
Mailing address:
  • Phone: 916-642-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number41108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: