Healthcare Provider Details

I. General information

NPI: 1417432147
Provider Name (Legal Business Name): JANETTE BAJO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANETTE MARINAS VILLACARLOS

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 CAPITOL AVE DEPT 304
SACRAMENTO CA
95816-6006
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-262-9414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNP95008475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: