Healthcare Provider Details

I. General information

NPI: 1972066686
Provider Name (Legal Business Name): ANDREA KATHLEEN ANSARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST STE 1200
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V ST STE 1200
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 503-970-2990
  • Fax:
Mailing address:
  • Phone: 503-970-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA195277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: