Healthcare Provider Details

I. General information

NPI: 1447061726
Provider Name (Legal Business Name): EDJEMAR XYRIL PADERNA LOSITO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 OWL CT
WEST SACRAMENTO CA
95691-6453
US

IV. Provider business mailing address

3302 OWL CT
WEST SACRAMENTO CA
95691-6453
US

V. Phone/Fax

Practice location:
  • Phone: 916-579-9998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95035992
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number95035992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: