Healthcare Provider Details

I. General information

NPI: 1669002606
Provider Name (Legal Business Name): AUSTIN BIRD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W MONTE VISTA AVE
VACAVILLE CA
95688-3898
US

IV. Provider business mailing address

100 W MONTE VISTA AVE
VACAVILLE CA
95688-3898
US

V. Phone/Fax

Practice location:
  • Phone: 707-453-6011
  • Fax:
Mailing address:
  • Phone: 707-453-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240018520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: