Healthcare Provider Details

I. General information

NPI: 1346115151
Provider Name (Legal Business Name): YELENA NEVEROV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 HARBOR BLVD
WEST SACRAMENTO CA
95691-2201
US

IV. Provider business mailing address

2945 DENISE CT
WEST SACRAMENTO CA
95691-4230
US

V. Phone/Fax

Practice location:
  • Phone: 916-372-8525
  • Fax: 916-372-5971
Mailing address:
  • Phone: 916-372-8525
  • Fax: 916-372-5971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number19597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: