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General NPI Number Information
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NPI Number | 1619009487
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Entity Type | Individual
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Provider Name | NAOMI CELINA WADE
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Gender | Female
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4600 47TH AVE STE 111
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City | SACRAMENTO
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State | CA
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Zip | 95824-3923
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Country | US
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Telephone | 916-393-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 5949 LAKE CREST WAY APT 14
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City | SACRAMENTO
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State | CA
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Zip | 95822-3328
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Country | US
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Telephone | 916-912-8014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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