Healthcare Provider Details

I. General information

NPI: 1164465357
Provider Name (Legal Business Name): RANDALL L STENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CAPITOL AVE STE A
SACRAMENTO CA
95816-5721
US

IV. Provider business mailing address

2100 CAPITOL AVE
SACRAMENTO CA
95816-5721
US

V. Phone/Fax

Practice location:
  • Phone: 916-442-4985
  • Fax: 916-442-7154
Mailing address:
  • Phone: 916-442-4985
  • Fax: 916-442-7154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberG25548
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberDEAX58196190
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberG25548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: