Healthcare Provider Details

I. General information

NPI: 1437619533
Provider Name (Legal Business Name): CHRISTINE JOY LICATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 BELL EXECUTIVE LN
SACRAMENTO CA
95825-4068
US

IV. Provider business mailing address

2300 BELL EXECUTIVE LN
SACRAMENTO CA
95825-4068
US

V. Phone/Fax

Practice location:
  • Phone: 925-685-4224
  • Fax: 925-685-6997
Mailing address:
  • Phone: 925-685-4224
  • Fax: 925-685-6997

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 Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA176389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: