Healthcare Provider Details

I. General information

NPI: 1033041157
Provider Name (Legal Business Name): URSULA M MACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 AUBURN BLVD
SACRAMENTO CA
95821-2005
US

IV. Provider business mailing address

7201 SUNCREEK WAY
ORANGEVALE CA
95662-2435
US

V. Phone/Fax

Practice location:
  • Phone: 916-482-2370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: