Healthcare Provider Details

I. General information

NPI: 1063949766
Provider Name (Legal Business Name): MR. AVIK DATTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 ROSIN CT STE 170
SACRAMENTO CA
95834-1658
US

IV. Provider business mailing address

4801 34TH ST
SACRAMENTO CA
95820-4849
US

V. Phone/Fax

Practice location:
  • Phone: 916-567-4222
  • Fax:
Mailing address:
  • Phone: 916-737-9202
  • Fax: 916-737-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: