Healthcare Provider Details

I. General information

NPI: 1689157091
Provider Name (Legal Business Name): RAKIAYA SHAYREE' MIXON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7415 HENRIETTA DR
SACRAMENTO CA
95822-5142
US

IV. Provider business mailing address

7415 HENRIETTA DR
SACRAMENTO CA
95822-5142
US

V. Phone/Fax

Practice location:
  • Phone: 916-520-7399
  • Fax: 916-520-7398
Mailing address:
  • Phone: 916-520-7399
  • Fax: 916-520-7398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number90415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: