Healthcare Provider Details

I. General information

NPI: 1497686695
Provider Name (Legal Business Name): DAVID A ITEMERE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6419 MATTERHORN DR
SACRAMENTO CA
95842-2627
US

IV. Provider business mailing address

6419 MATTERHORN DR
SACRAMENTO CA
95842-2627
US

V. Phone/Fax

Practice location:
  • Phone: 410-963-9395
  • Fax:
Mailing address:
  • Phone: 410-963-9395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number345920344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: