Healthcare Provider Details

I. General information

NPI: 1306129853
Provider Name (Legal Business Name): FIJIAN ANGEL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4757 J ST
SACRAMENTO CA
95819-3700
US

IV. Provider business mailing address

4757 J ST
SACRAMENTO CA
96819
US

V. Phone/Fax

Practice location:
  • Phone: 916-476-3325
  • Fax:
Mailing address:
  • Phone: 916-476-3325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number155056
License Number StateCA

VIII. Authorized Official

Name: MRS. VENAISI V TAUKEINIKORO
Title or Position: OWNER
Credential:
Phone: 916-476-3325