Healthcare Provider Details

I. General information

NPI: 1447798111
Provider Name (Legal Business Name): NICOLE KLOPOVIC PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 EXPOSITION BLVD
SACRAMENTO CA
95815-5149
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-731-7728
  • Fax: 916-731-7815
Mailing address:
  • Phone: 800-470-0010
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number54175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: