Healthcare Provider Details

I. General information

NPI: 1245826445
Provider Name (Legal Business Name): ADRIENNE KOOS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST # 200
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST # 200
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-4747
  • Fax:
Mailing address:
  • Phone: 916-734-3761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number20A25224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: