Healthcare Provider Details

I. General information

NPI: 1992398887
Provider Name (Legal Business Name): THEODORE MEHRON EGHDAMI MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5743 BLACHLY WAY APT 2
SACRAMENTO CA
95841-2458
US

IV. Provider business mailing address

5743 BLACHLY WAY APT 2
SACRAMENTO CA
95841-2458
US

V. Phone/Fax

Practice location:
  • Phone: 971-295-4202
  • Fax:
Mailing address:
  • Phone: 971-295-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: