Healthcare Provider Details

I. General information

NPI: 1780667360
Provider Name (Legal Business Name): JOEL PAUL BRESOLIN N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 MORSE AVE
SACRAMENTO CA
95825
US

IV. Provider business mailing address

2016 MORSE AVE
SACRAMENTO CA
95825
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-7765
  • Fax: 855-414-1745
Mailing address:
  • Phone: 916-973-7765
  • Fax: 855-414-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberNP11409
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberRN432043
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number432043
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number432043
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number432043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: