Healthcare Provider Details

I. General information

NPI: 1043095466
Provider Name (Legal Business Name): ABIGAIL ROSE BRACKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7248 S LAND PARK DR STE 103
SACRAMENTO CA
95831-3661
US

IV. Provider business mailing address

7248 S LAND PARK DR STE 103
SACRAMENTO CA
95831-3661
US

V. Phone/Fax

Practice location:
  • Phone: 916-921-0828
  • Fax:
Mailing address:
  • Phone: 916-921-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: