Healthcare Provider Details

I. General information

NPI: 1356458616
Provider Name (Legal Business Name): NI NI HLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 HARVARD ST STE 210
SACRAMENTO CA
95815-3318
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 916-567-3500
  • Fax: 916-567-3501
Mailing address:
  • Phone: 916-576-7900
  • Fax: 916-285-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberAQ94426
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA94426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: