Healthcare Provider Details

I. General information

NPI: 1962242966
Provider Name (Legal Business Name): MR. NICHOLI REECE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

8129 WHITE KITE DR
SACRAMENTO CA
95832-7005
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5590
  • Fax:
Mailing address:
  • Phone: 510-298-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: