Healthcare Provider Details

I. General information

NPI: 1871676759
Provider Name (Legal Business Name): KARIMEH BORGHEI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 STOCKTON BLVD STE D
SACRAMENTO CA
95817-1418
US

IV. Provider business mailing address

PO BOX 524
WOODLAND CA
95776-0524
US

V. Phone/Fax

Practice location:
  • Phone: 916-703-5600
  • Fax:
Mailing address:
  • Phone: 530-662-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22652
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16898
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number546193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: