Healthcare Provider Details

I. General information

NPI: 1356112262
Provider Name (Legal Business Name): KADRA BEVERLY VACCARO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KADRA BEVERLY RADEMACHER

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7248 S LAND PARK DR STE 205
SACRAMENTO CA
95831-3661
US

IV. Provider business mailing address

7248 S LAND PARK DR STE 205
SACRAMENTO CA
95831-3661
US

V. Phone/Fax

Practice location:
  • Phone: 916-392-4000
  • Fax:
Mailing address:
  • Phone: 916-392-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: