Healthcare Provider Details

I. General information

NPI: 1457016842
Provider Name (Legal Business Name): JASON RICHARD SHATZER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7880 ALTA VALLEY DR STE 107
SACRAMENTO CA
95823-4908
US

IV. Provider business mailing address

7880 ALTA VALLEY DR STE 107
SACRAMENTO CA
95823-4908
US

V. Phone/Fax

Practice location:
  • Phone: 916-868-1815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: