Healthcare Provider Details

I. General information

NPI: 1659612596
Provider Name (Legal Business Name): MS. CHRISTINA MARIE CLEVENGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 47TH AVE STE 111
SACRAMENTO CA
95824-3923
US

IV. Provider business mailing address

4120 PAIGE CT
ROCKLIN CA
95677-3109
US

V. Phone/Fax

Practice location:
  • Phone: 916-318-0141
  • Fax:
Mailing address:
  • Phone: 408-509-6948
  • 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: