Healthcare Provider Details

I. General information

NPI: 1013243724
Provider Name (Legal Business Name): MICHELLE GAYMON PDC(DONA), AAHCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 42ND ST
SACRAMENTO CA
95819-3113
US

IV. Provider business mailing address

635 42ND ST
SACRAMENTO CA
95819-3113
US

V. Phone/Fax

Practice location:
  • Phone: 916-320-7172
  • Fax:
Mailing address:
  • Phone: 916-320-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: