Healthcare Provider Details

I. General information

NPI: 1154356723
Provider Name (Legal Business Name): SAJIV SAXENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 W GIBSON RD
WOODLAND CA
95695
US

IV. Provider business mailing address

632 W GIBSON RD
WOODLAND CA
95695
US

V. Phone/Fax

Practice location:
  • Phone: 530-666-1631
  • Fax: 530-668-4839
Mailing address:
  • Phone: 530-666-1631
  • Fax: 530-297-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC51376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: