Healthcare Provider Details

I. General information

NPI: 1740547710
Provider Name (Legal Business Name): DAVID GAINES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 07/10/2021
Certification Date: 07/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 W EL CAMINO AVE STE 260
SACRAMENTO CA
95833-1868
US

IV. Provider business mailing address

PO BOX 254788
SACRAMENTO CA
95865-4788
US

V. Phone/Fax

Practice location:
  • Phone: 916-877-5220
  • Fax:
Mailing address:
  • Phone: 916-877-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: