Healthcare Provider Details

I. General information

NPI: 1740136068
Provider Name (Legal Business Name): PHYSICIAN ASSISTANT CONSULTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 LONE PINE RD
SEBASTOPOL CA
95472-5623
US

IV. Provider business mailing address

2108 N ST STE 4588
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 707-861-1187
  • Fax: 707-261-0786
Mailing address:
  • Phone: 707-861-1187
  • Fax: 707-261-0786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. ROSEANNA MARIA DUENAS
Title or Position: CEO
Credential: PA-C
Phone: 707-861-1187