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General NPI Number Information
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NPI Number | 1306198296
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Entity Type | Organization
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Legal Business Name | HEALTH AND LIFE ORGANIZATION, INC
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 2138 DEL PASO BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95815-3002
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Country | US
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Telephone | 916-428-3788
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Fax |
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Provider Business Mailing Address
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Address Line | 2138 DEL PASO BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95815-3002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JERRY T BLIATOUT
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Credential | JD
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Telephone | 916-428-3788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | CA
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