Healthcare Provider Details

I. General information

NPI: 1316400609
Provider Name (Legal Business Name): GREGORY SCOTT BRITTENHAM JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 STOCKTON BLVD NORTH ADDITION 5TH FLOOR
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2335 STOCKTON BLVD NORTH ADDITION 5TH FLOOR
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2724
  • Fax:
Mailing address:
  • Phone: 916-734-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number20A19375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: