Healthcare Provider Details

I. General information

NPI: 1962453902
Provider Name (Legal Business Name): DORA ELVA BUCKHALTER PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 HOSPITAL DR STE 203
SACRAMENTO CA
95823-5405
US

IV. Provider business mailing address

7501 HOSPITAL DR STE 203
SACRAMENTO CA
95823-5405
US

V. Phone/Fax

Practice location:
  • Phone: 916-681-1130
  • Fax: 916-681-1133
Mailing address:
  • Phone: 916-681-1130
  • Fax: 916-681-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 16135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: