Healthcare Provider Details

I. General information

NPI: 1588313381
Provider Name (Legal Business Name): MAYUR VORA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 J ST
SACRAMENTO CA
95819-3626
US

IV. Provider business mailing address

3939 J ST STE 104
SACRAMENTO CA
95819-3631
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-4768
  • Fax: 916-733-6977
Mailing address:
  • Phone: 916-453-4768
  • Fax: 916-733-6977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95027894
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95027894
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95027894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: