Healthcare Provider Details

I. General information

NPI: 1689399289
Provider Name (Legal Business Name): TAYLOR RAEANNE FONG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 N POINT WAY
SACRAMENTO CA
95831-1066
US

IV. Provider business mailing address

6210 N POINT WAY
SACRAMENTO CA
95831-1066
US

V. Phone/Fax

Practice location:
  • Phone: 916-225-3942
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2787
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: