Healthcare Provider Details

I. General information

NPI: 1962207001
Provider Name (Legal Business Name): PAULINE DOLLAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 UNIVERSITY AVE STE 120
SACRAMENTO CA
95825-6532
US

IV. Provider business mailing address

5026 LADY DI WAY
ELK GROVE CA
95758-4170
US

V. Phone/Fax

Practice location:
  • Phone: 916-929-8564
  • Fax:
Mailing address:
  • Phone: 209-445-5603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: