Healthcare Provider Details

I. General information

NPI: 1144208885
Provider Name (Legal Business Name): BRANDEE LYNN WAITE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST SUITE 3850
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST SUITE 3850
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5291
  • Fax: 916-734-7838
Mailing address:
  • Phone: 916-734-5291
  • Fax: 916-734-7838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA79238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: