Healthcare Provider Details

I. General information

NPI: 1740928365
Provider Name (Legal Business Name): SITARA NIRANJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V ST STE 3400
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3565
  • Fax:
Mailing address:
  • Phone: 916-734-3565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA203264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: