Healthcare Provider Details

I. General information

NPI: 1649243528
Provider Name (Legal Business Name): REBECCA S JORDAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA PICKELL SANGALANG M.D.

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 HOSPITAL DR SUITE G
SACRAMENTO CA
95823-5406
US

IV. Provider business mailing address

7600 HOSPITAL DR SUITE G
SACRAMENTO CA
95823-5406
US

V. Phone/Fax

Practice location:
  • Phone: 916-525-2021
  • Fax: 916-525-2065
Mailing address:
  • Phone: 916-688-3181
  • Fax: 916-688-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA53618
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA53618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: