Healthcare Provider Details

I. General information

NPI: 1902378383
Provider Name (Legal Business Name): SCOTT DANIEL AHLQUIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9218 FALKLAND WAY
SACRAMENTO CA
95826-2231
US

IV. Provider business mailing address

9218 FALKLAND WAY
SACRAMENTO CA
95826-2231
US

V. Phone/Fax

Practice location:
  • Phone: 916-289-7586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: