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NPI Code Detail

MEDICARE: MS. KATHEIRNE NOELLE MAYORGA-ELTON ASW

MEDICARE: MS. KATHEIRNE NOELLE MAYORGA-ELTON ASW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerASW76990CA

General Provider Information

NPI Number : 1043795610
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHEIRNE NOELLE MAYORGA-ELTON ASW
Provider Business Mailing Address
First Line : 4250 AUBURN BLVD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95841-4164
Country : US
Telephone Number : 916-489-3336
Fax Number :
Provider Business Practice Location Address
First Line : 4250 AUBURN BLVD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95841-4164
Country : US
Telephone Number : 916-489-3336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2018
Last Update Date : 09/30/2018

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