Healthcare Provider Details

I. General information

NPI: 1023672342
Provider Name (Legal Business Name): JOSEPH ADDUCCI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 JEFFERSON BLVD
WEST SACRAMENTO CA
95691-5313
US

IV. Provider business mailing address

2455 JEFFERSON BLVD STE 100
WEST SACRAMENTO CA
95691-5329
US

V. Phone/Fax

Practice location:
  • Phone: 916-617-2377
  • Fax:
Mailing address:
  • Phone: 916-617-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA56878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: