Healthcare Provider Details

I. General information

NPI: 1740713734
Provider Name (Legal Business Name): JENIKA FERRETTI-GALLON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 11/22/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 101
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST STE 101
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2737
  • Fax:
Mailing address:
  • Phone: 916-734-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD89383
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA172106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: