=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689083644
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EL HOGAR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2014
-----------------------------------------------------
Last Update Date | 08/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3780 ROSIN CT
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95834-1646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-441-0226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3780 ROSIN CT
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95834-1646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | BONNIE LANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-559-6572
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------