Healthcare Provider Details

I. General information

NPI: 1740819200
Provider Name (Legal Business Name): JOHN DAVID HOSLEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3647 40TH ST
SACRAMENTO CA
95817-3609
US

IV. Provider business mailing address

3647 40TH ST
SACRAMENTO CA
95817-3609
US

V. Phone/Fax

Practice location:
  • Phone: 916-452-1068
  • Fax: 916-469-9415
Mailing address:
  • Phone: 916-452-1068
  • Fax: 916-469-9415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA57783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: