Healthcare Provider Details

I. General information

NPI: 1336839133
Provider Name (Legal Business Name): MICHAELA CONTRERAS CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 MADISON AVE # A91
SACRAMENTO CA
95841-5600
US

IV. Provider business mailing address

5015 MADISON AVE # A91
SACRAMENTO CA
95841-5600
US

V. Phone/Fax

Practice location:
  • Phone: 916-626-7777
  • Fax:
Mailing address:
  • Phone: 916-626-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT02163512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: