Healthcare Provider Details

I. General information

NPI: 1679790679
Provider Name (Legal Business Name): PAUL L. BACIGALUPI II RN, BSN, PHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 NORTH COTTONWOOD STREET SUITE 2450
WOODLAND CA
95695
US

IV. Provider business mailing address

2542 FARMER'S CENTRAL ROAD
WOODLAND CA
95776
US

V. Phone/Fax

Practice location:
  • Phone: 530-666-8645
  • Fax: 530-669-1549
Mailing address:
  • Phone: 530-669-3516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number575703
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number575703
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number575703
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number575703
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number575703
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number575703
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number575703
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number575703
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number575703
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number575703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: