Healthcare Provider Details

I. General information

NPI: 1851616056
Provider Name (Legal Business Name): KELLY BETH HAAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY BETH TRANGSRUD

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 STOCKTON BLVD STE 367
SACRAMENTO CA
95817-2208
US

IV. Provider business mailing address

2516 STOCKTON BLVD STE 367
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3720
  • Fax: 916-734-4098
Mailing address:
  • Phone: 916-734-3720
  • Fax: 916-734-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberA120042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: