Healthcare Provider Details

I. General information

NPI: 1841713732
Provider Name (Legal Business Name): WELLSPACE HEALTH PROFESSIONAL HEALTH CENTER FOR WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EXPO PKWY
SACRAMENTO CA
95815-4227
US

IV. Provider business mailing address

1500 EXPO PKWY
SACRAMENTO CA
95815-4227
US

V. Phone/Fax

Practice location:
  • Phone: 916-469-4690
  • Fax:
Mailing address:
  • Phone: 916-550-5481
  • Fax: 916-520-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KARINA VANESSA MARTIN
Title or Position: FACILITY LICENSING SPECIALIST
Credential:
Phone: 916-469-4690